A decision support tool is provided for predicting the neonatal vitality scores of a fetus during delivery, the scores being an indicator of future health for the infant anticipated to be born within a future time interval, measured as time to birth. The predicted neonatal vitality score is determined from measurements of physiological variables monitored during labor, such as uterine activity and fetal heart rate. Fetal heart rate variability and patterns may be detected and computed using the monitored physiological variables, and neonatal vitality scores may be predicted based, at least in part, on the variability metrics and fetal heart rate patterns. Scores may be predicted for different delivery methods, such as vaginal delivery or cesarean delivery, for different time-to-birth intervals. In this way, these scores may be used for decision support for care plans during labor, such as increased monitoring and/or modifying the delivery type.