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What is the Bishop Score, and Why Does it Matter for Induction?
- bbdoulamt
- 22 hours ago
- 5 min read
Induction of labor may be either desired or necessary at the end of pregnancy. One of the tools used to help determine how successful an induction may be is called the Bishop Score. But remember, this is just a tool and is not a guarantee of an outcome.
What is the Bishop Score?
The Bishop Score is named after Edward Bishop, who in 1964, published a scoring system used to predict the success of labor inductions. The Bishop Score takes into account 5 components of a pelvic exam to come up with a total score ranging from 0 – 13. The five components of the pelvic exam are: Cervical Position, Cervical Consistency, Cervical Effacement, Cervical Dilation and Fetal Station.
How the score is determined:
• Cervical Position can score between 0 and 2 points. As labor draws closer, the cervix moves forward from and a posterior position to an anterior position. If the cervix is posterior, it would score 0 points, if it was anterior it would score 2 and a middle positioned cervix would score 1 point.
• Cervical Consistency can also score between 0 and 2 points. As the cervix is preparing for birth, the consistency will soften, which allows for stretching and opening for the baby to come through. A firm cervix would score 0 points and a soft cervix would score 2.
• Cervical Effacement can score between 0 and 3 points. Effacement is the thinning of the cervix as birth approaches. Normally the cervix is around 3 centimeters long. By the time it is fully effaced, it is paper thin. This score is based on the percent that the cervix is effaced.
• Cervical Dilation can score between 0 and 3 points. Dilation measures how open the cervix is. This is one of the most important factors in the Bishop Score. More than 5 cm dilated will score a 3 where a completely closed cervix will score 0 points.
• Fetal Station will score between 0 and 3 points. Fetal Station measures the position of the baby's head or presenting part in relation to the mother's pelvis.
Score | |
Cervical Position | 0-2 |
Cervical Consistency | 0-2 |
Cervical Effacement | 0-3 |
Cervical Dilation | 0-3 |
Fetal Station | 0-3 |
Total: |
What Does Your Bishop Score Tell You?
The points from each category are then totaled. The higher the score, the higher the chance is of a successful induction. A score of 8 or more is considered favorable, and a score of 6 or less is unfavorable. However, with a score of 6 or less, ripening agents (these help the cervix soften and open) may be used before an induction begins.
After a score is determined, along with taking into consideration the health of both mother and baby, a decision on labor induction may be more easily made. For example, a woman with preeclampsia may need to be induced even with a low Bishop Score. In this case, using ripening agents may be needed to help an induction be successful.
Modified Bishop Score
After Edward Bishop published the Bishop Score, additional research showed that using a modified score could be just as accurate as using the original 5 components. When using a modified Bishop Score, cervical effacement, dilation and fetal station are used along with a modified score total.
It is important to remember that the Bishop Score is only a tool that can be used to predict the success of an induction. A high Bishop Score is not a guarantee of a successful natural birth, and a low score does not mean a natural birth is impossible. It is only one piece of a larger picture.
Other Factors
Baby's position: A posterior baby cannot put the pressure on the cervix that is needed for the cervix to efface and dilate. In that case, trying to help the baby get into an anterior position is helpful before an induction is started.
Individual Variation: It is also important to keep in mind that different women can efface and dilate at different speeds. It can be completely normal to walk around for 2 weeks partially dilated and also completely normal not to be dilated at all when labor begins.
Medical Induction Methods
In a medical induction Pitocin (a synthetic form of Oxytocin) is commonly used once the cervix has ripened. If the cervix is not ripe other medications/methods can be used to help the process along before Pitocin is started. Caregivers can also strip the membranes (loosen the bag of waters from the uterine wall) or artificially rupture the membranes (break the waters) to attempt to get labor to start on its own.
Non-Medical Induction Methods
Walking sometimes helps labor begin, however it's more helpful for speeding up a slow labor than helping labor start. Walking can be a good source of exercise and a distraction when waiting for labor to start. But remember, don’t wear yourself out!
Nipple Stimulation causes the body to release oxytocin. This may be a better method to try if your Bishop Score is higher.
Sexual intercourse not only causes the release of oxytocin, but also of prostaglandins (a chemical compound that helps the cervix to soften and open). This is a better method if your Bishop Score is lower as it can help your cervix ripen. However, if your water has broken, do not put anything in your vagina as this can increase the risk of infection.
Castor Oil is a strong laxative that can cause the bowels to empty. Contractions may start as a result. (Use with caution & guidance from provider!)
Acupressure on certain points can start contractions, or speed them up. It can also help with pain management during labor. The two most popular spots are the Hoku (on your hand) and Spleen 6 (a little above the inside of your ankle.) It is important to not use Acupressure on these points before 38 weeks as it can increase your risk of preterm labor.
Take Away:
Inducing labor may become either desired or necessary to protect mom, baby or both. The Bishop Score is a tool that can be helpful in deciding on inducing labor. There are various methods of labor induction both medically and non-medically. Understanding your options and your own unique situation can help facilitate good conversations with your care team and help you make informed decisions on how to proceed.
Resources:
Pregnancy, Childbirth and the Newborn: The Complete Guide by Penny Simpkin, Janet Whalley, Ann Keppler, Janelle Durham, April Bolding
The Birth Partner by Penny Simpkin
Catharine is a birth doula and a stay home/homeschool mama of 5. She has a passion for serving women on their motherhood journey. Catharine believes the memories surrounding birth are some of the most precious memories in a woman's life. How she is cared for during this precious and vulnerable time will make a big impact on her life. Each birth is unique and Catharine seeks to provide education and support so each mother can make informed decisions that are best for her. Her desire is that each mother can look back on her birth knowing she was loved and well cared for.
If you are looking for doula support for your birth journey please reach out!
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Disclaimer: The information on this website is intended solely for educational purposes. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always discuss any questions or concerns with your provider.
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