Many pregnant women haven’t heard about Bishop’s score before, let alone know what it means. But if you’re a thinking woman (or man) who likes to make informed decisions, it can be a helpful concept to understand. This article will explain everything you need to know about Bishop’s score.
In certain circumstances, your care provider might recommend an induction of labour. Induction should be reserved for situations where the risks of continuing the pregnancy are greater than the risks of giving birth before labour begins on its own. Because the process of induction forces your body to begin labour before it’s ready, there is an increased risk of interventions and c-section.
Find out more about the risks of inducing labour.
If you are facing an induction for medical reasons, it can be useful to know how close to labour you are. One of the ways this can be done is with the Bishop’s score.
What Is A Bishop’s Score?
In the 1960s, Dr Edward Bishop developed a pelvic scoring system to determine the likelihood of a woman going into labour in the immediate future. Today it’s used to predict how likely an induction will result in a vaginal birth, or whether induction is necessary.
The score takes into consideration different factors about your cervix, and your baby’s position:
- Cervical dilation: how far your cervix has opened in centimetres.
- Cervical effacement: how thin the cervix is. Normally the cervix is about 3 cms long. When labour begins, the cervix will efface until it’s paper thin.
- Cervical consistency: whether the cervix feels soft or firm. In first pregnancies, the cervix is usually firmer than in women who have had previous pregnancies.
- Cervical position: your cervix changes position when labour gets closer, moving from facing backwards to forwards.
- Fetal station: this is where the baby’s head is in relation to the distance from the ischial spines (bony protuberances low on the pelvis).
Each factor is given a ‘grade’ and then these are added up to give an overall score. Some care providers use a modified Bishop’s score – using only dilation, station and effacement – and will add or subtract a point for certain factors, such as previous vaginal births, being post 40 weeks, or the presence of pre-eclampsia.
What Does The Bishop’s Score Mean?
Knowing how ready your body is for labour can help you and your care provider decide whether induction is necessary, or what method to use.
A high Bishop’s score means a higher chance of successful induction. A low Bishop’s score means a lower chance of successful induction. The score is broken down like this:
- A score of 8 or more: indicates labour is likely to start spontaneously in the near future. If an induction is urgently necessary, it’s most likely to be successful.
- A score of 6 to 7: it’s not likely labour will start spontaneously soon. An induction might or might not be successful.
- A score of 5 or less: indicates labour is not going to start spontaneously soon, and an induction is unlikely to be successful.
How Accurate Is The Bishop’s Score?
There is no concrete way of knowing whether labour is going to begin in the next few hours, days or weeks – except by waiting for labour to begin. Each woman’s body is unique, and how labour unfolds for her depends on a few factors.
If you have a low Bishop’s score, it’s worth having the position of your baby confirmed. Babies who are in the posterior position (back of the head facing your back) are not able to put effective pressure on the cervix, encouraging it to thin and dilate. The cervix is often pointed towards the back (posterior) and hard to reach during a vaginal examination.
When babies are in the occiput position (back of the head facing your belly), the largest part of the baby’s head is over the cervix. The pressure of the baby’s head encourages the cervix to thin and dilate. If the baby is encouraged out of the posterior position, the Bishop’s score can change quite dramatically.
Inducing babies in the posterior position usually results in a very long and hard labour. The mother can become very tired and discouraged, request pain relief, and be more likely to have a c-section.
If you have a low Bishop’s score and your baby is posterior, it could be that your body isn’t ready to go into labour until your baby is in the ideal birthing position. It might help to have body therapy, or use some of the techniques from Spinning Babies, to help encourage your baby into the occiput position.
Being Induced With A Low Score
Research shows being induced with a low Bishop’s score significantly increases the risk of c-section birth.
Another study looked at women who were induced with a Bishop’s score of less than 7. The c-section rate among these women was 42% for first time mothers, and 14% for women having subsequent pregnancies.
This shows how important it is to allow the cervix to ripen before inducing labour, especially in first-time pregnant women, whose cervices have never dilated before.
If induction is not urgent, you might be able to wait for your cervix to ripen naturally. Some women feel they want to do something to help this process, and there are several ways to try to speed things up (read BellyBelly’s article on natural methods to bring on labour).
In some situations it’s not safe for you or your baby to wait, and induction becomes urgent. Your care provider might suggest using drugs to ripen the cervix before starting the induction process. If this is the only option available in an urgent situation you might decide to go ahead, but bear in mind, cervical ripening methods are unlikely to help when there is a very low Bishop’s score.
If induction is being suggested, and you are confident it’s the right choice for you and your baby, having a Bishop’s score can help you make the best decision about how and when to induce. If a medical condition makes induction necessary, and you have an unripe cervix, consider how to increase cervical ripeness naturally before the induction, and allow enough time for these methods to be effective.
Recommended Reading: Why All Inductions Are Not The Same – 5 Induction Methods and What Causes Labour To Start.