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 auscultation 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 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.