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Maternal mortality is a major public health crisis in the United States. Cardiovascular disease (CVD) is a leading cause of maternal mortality and morbidity. Labor and delivery is a vulnerable time for pregnant individuals with CVD but there is significant heterogeneity in the management of labor and delivery in high-risk patients due in part to paucity of high-quality randomized data. The authors have convened a multidisciplinary panel of cardio-obstetrics experts including cardiologists, obstetricians and maternal fetal medicine physicians, critical care physicians, and anesthesiologists to provide a practical approach to the management of labor and delivery in high-risk individuals with CVD. This expert panel will review key elements of management from mode, timing, and location of delivery to use of invasive monitoring, cardiac devices, and mechanical circulatory support., Competing Interests: Dr Lau is supported by the 10.13039/100000002NIH (K23-HL159243) and the 10.13039/100000968American Heart Association (853922). Dr Briller is supported by the REBIRTH trial. Dr Malhamé is supported by a 10.13039/501100020951Fonds de recherche du Québec – Santé Career award. Dr Quesada is supported by the 10.13039/100000002NIH (K23-HL151867). Dr Meng is supported by the 10.13039/100005831Foundation for Anesthesia Education and Research. Dr Scott is supported by the HOPE registry and the REBIRTH trial. Dr Lau has previously consulted for Roche Diagnostics and Astellas Pharma. Dr Mattina is a paid consultant for Zoll Medical. Dr Harrington is a paid consultant for AllWays Health Partners and Quidelortho. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)