The purpose of this document is to: 1) review nomenclature for fetal heart rate assessment, 2) review the data on the efficacy of electronic fetal monitoring (EFM), and 3) delineate the strengths and shortcomings of EFM. It also compares international three-tier systems for fetal heart rate tracing, including the National Institute of Child Health and Human Development (NICHD), Society of Obstetricians and Gynecologists of Canada (SOGC) and the Royal College of Obstetricians and Gynecologists (RCOG, United Kingdom). The collaboration of practitioners in defining the interpretation and implementing is critical for improved care for women and children. Realizing that this information deserves wide dissemination, Women’s Health and Education Center (WHEC) encourages its translations and adaptations.