Position
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) maintains that the availability of registered nurses (RNs) and other health care professionals who are skilled in fetal heart monitoring (FHM) techniques, including intermittent auscultation (IA) and electronic fetal monitoring (EFM), is essential to maternal and fetal well-being during antepartum care, labor, and birth. Fetal heart monitoring requires advanced assessment and clinical judgment skills and should not be delegated to unlicensed assistive personnel or others who do not possess the appropriate licensure, education, and skills validation. A woman’s preferences and clinical presentation should guide the selection of FHM techniques. In general, the least invasive method of monitoring is preferred to promote physiologic labor and birth. Labor is dynamic; therefore, consideration of preferences and identification of risk factors should occur upon admission to the birth setting and should be ongoing throughout labor.
Background
The intent of intrapartum fetal surveillance is to assess uterine activity and fetal heart rate (FHR) response to labor to make appropriate, physiologically based clinical decisions (American College of Obstetricians and Gynecologists, 2021; Lyndon and O’Brien-Abel, 2021). Fetal heart monitoring includes initial and ongoing assessments of the woman and fetus, use of monitoring techniques such as IA or EFM, interpretation of FHM data, and provision of clinical interventions, as needed. Regardless of the setting, each aspect of FHM should be performed by a licensed, experienced, health care professional consistent with the scope of practice as defined by appropriate state regulations. These health care professionals include registered nurses, certified nurse-midwives, certified midwives, and other advanced practice nurses such as nurse practitioners and clinical nurse specialists, physicians, and physician assistants.