Fetal blood testing is a transvaginal (via the vagina) procedure performed during active labor. The scalp of the fetus is cleansed and pierced, and a small blood sample is taken for evaluation.

The procedure typically takes about 5 minutes. You will be placed in the lithotomy position (on your back with your knees and legs pulled toward your chest). If your cervix is already dilated at least 3 to 4 centimeters, a plastic cone is placed in your vagina and fit snuggly against the scalp of the fetus.

The scalp is cleansed and dried with long cotton swabs, and a small amount of petroleum jelly is applied so the blood droplets will form beads for easier collection. A small puncture is made in the scalp and blood droplets are collected in a thin tube. The tube is either sent to the hospital laboratory or analyzed by a machine in the labor and delivery department. In either case, results are available in just a few minutes.

If you are unable to be still, it will be very difficult to perform this test. If your cervix is not dilated enough, it is impossible to perform this test.

The procedure should feel like a long pelvic exam. At this stage of labor, many patients already have an epidural in place and may not feel the procedure at all.

Usually this test is performed to obtain information about fetal acid-base balance (blood pH). Sometimes fetal heart monitoring doesn't provide enough information about the well-being of your baby. In these cases, testing the scalp pH can help your doctor decide whether the fetus is getting enough oxygen during labor. This helps determine whether your baby is healthy enough to continue labor, or if a forceps delivery or cesarean section might be the best route of delivery.

Although the test is not uncommon, most deliveries do not involve fetal scalp pH testing.

• Normal: 7.25 to 7.35
• Borderline: 7.20 to 7.25
• Low: less than 7.20

In general, low pH suggests that the baby is not tolerating labor very well. However, the results of a fetal scalp pH sample need to be interpreted in the context of each individual delivery. Ask your doctor to explain your results to you. Your doctor may find the results reassuring, and labor may continue as before. Alternatively, he or she may feel that the results indicate that the baby needs to be delivered in a hurry, either by forceps or by cesarean section.

The results may not really point in either direction, and the test may need to be repeated in 20-30 minutes. It may need to be repeated a few times during a complicated labor.

Low pH values in cord blood taken from an umbilical cord artery can also suggest that the fetus is not getting enough oxygen during labor. Because scalp pH testing is only one of many tests by which your doctor can evaluate your baby during labor, the results must be interpreted in context. Your doctor will explain any results to you.

• Continued bleeding from the puncture site (more likely if the fetus has a pH imbalance)
• Infection
• Fetal scalp bruising

This test may not be advised for HIV-positive mothers or in mothers who carry the hepatitis C virus. In these cases, your doctor may feel that the procedure increases the risk of transmitting infection to your baby.