The Bishop Score: An Evidence-Based Tool When Considering an Induction

Are you considering an induction of labor? Have you been offered an induction of labor as you near your due date? Remember to ask your provider about your Bishop Score! Say what? 

Bishop Score

What is the Bishop Score?

The Bishop Score is a calculation that is used to determine how likely it is that a medical induction of labor will be successful. It estimates how well prepared the body is for an induction. The Bishop score looks at cervical dilation, effacement, station, cervical consistency, and cervical placement. 

Dilation: the amount the cervix is open measured in centimeters

Effacement: how thin the cervix is (measured in percentages – for example – 80% is a very thin cervix)

Station: the position of baby’s head in the pelvis, measured from -3 (not in the pelvis) to +3 (birthing)

Cervical consistency: refers to firm or softness of the cervix

Cervical position: the position of the opening of the cervix from anterior (front) or posterior (back)

If your Bishop score is 8 or greater the chances of having a vaginal delivery are good and the cervix is said to be favorable for induction. If the Bishop score is 6 or less, the chances of having a vaginal delivery are low and the cervix is said to be unfavorable for induction. 

When is a Bishop Score used? 

The Bishop Score can be really useful information if your provider suggests a medical induction of labor. This is most commonly seen after 39 weeks, and I often see providers offer induction once a person is nearing their due date. It’s an important tool that you can use to give you an idea of how likely an induction is to lead to a vaginal birth. 

This is a very useful tool to consider if you are offered an induction of labor without urgent medical necessity. It is said to have about a 75-80% rate of successful prediction of vaginal birth. 

Be Aware of Coercion and Induction of Labor

This comes up in my work as a doula all the time. I have supported many families through an induction experience. There are many emotions and decision-making points that arise during the process and it can be incredibly helpful to talk it over with a neutral person who is 100% invested in you.

For example, your provider may suggest that you should schedule an induction for 41 weeks (sometimes even 39 or 40) to “get it on the schedule” just in case. You obviously can decline that induction, full stop, and wait for labor to start on its own. 

Be aware if your provider suggests an induction simply because their schedule is full next week. Also, be aware if you feel pressured to schedule it right away for their convenience. This is coercion and you do not have to comply. This might sound like, “Our schedule is fully booked next week, but if you come in tomorrow we can get you right in.” You can check out this blog post for more information to help you recognize coercion in maternity care. 

If there is truly a medical concern for induction of labor, then no one will say, “there’s no room in our schedule, sorry!” 

It’s a Complicated Decision, Everyone is Unique 

But, if you don’t want to keep waiting, and you feel safer knowing that you’ll have your baby soon, you can ask for your bishop score prior to induction. This will let you know if your cervix is favorable for an induction. It will let you know if an induction will be more likely to lead to a vaginal birth. 

The majority of research I have found shows that cervical dilation may be the most important factor in determining whether an induction will lead to a vaginal birth.

Your Cervix is Not a Crystal Ball, and Your Bishop Score is Not a Tarot Card Reading

All this being said, it’s important to know that your cervix isn’t a crystal ball. It’s not a rune. It can’t tell you the future of your labor or when you will go into labor. It doesn’t tell you what that experience will be like at all. 

If your plan is simply to wait for labor to start on its own, then cervical checks during pregnancy might be totally meaningless. This is especially true if you’re simply going to continue to wait for your body to do its thing. Any time you have a cervical check, you’re introducing the possibility of infection and rupture of membranes. If you’re planning to wait, then those checks aren’t going to give you any important information. 

A Bishop Score Can Give You Information to Help You Make a Decision

A bishop score can be really helpful when you’re trying to make a decision to wait or choose a medical induction of labor. There are many people who may not be comfortable waiting. There are a wide variety of personal reasons that people might choose an induction over waiting. 

You have to look at the risks/benefits and choose what feels right to you and your own unique situation. Some of the reasons that you may choose an induction are obviously medical conditions and concerns. Honestly, I feel like the clear medical decisions – for example an induction for preeclampsia, are simple decisions to make. This is simply because it is very clearly a medical issue and can be very serious. 

Sometimes, even without a medical cause, people may choose an induction. In this case, you can use the bishop score as a tool to help you determine if that decision works best for you. You can determine if it’s going to support you in meeting your goals for your birth. 

Even With a Bishop Score, Induction is a Complex Decision

Choosing an induction of labor is a complex decision. Every family is unique in their needs, dreams, and desires for their birth and for their family. Using a bishop score and looking at your goals and needs can help you look at the situation holistically to help you feel more confident in your decision-making process. 

You can also learn more about the Bishop Score on The Mindful Mama Birth Podcast!


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