Understanding the Bishop Score:
- Cordelia Thompson
- Oct 9, 2024
- 3 min read
Updated: Dec 4, 2024
The Bishop score, aka cervix score, is a simple method that helps predict how likely it is that a full-term pregnant mama will achieve a vaginal birth if induction is necessary. It can also help predict whether induction may or may not be necessary.
8 or more points. Bishop scores above eight indicate labor will most likely start spontaneously (and soon). It also indicates that if an induction is necessary, it will more than likely be successful.
6 to 7 points. Bishop scores in this range aren’t a great predictor one way or the other.
5 or fewer points. Low Bishop scores indicate that an induction is less likely to be successful. It also means that a woman who is ill or close to the 42-week mark is more likely to need an induction.
Based on this information and whether you and your baby are healthy, you can make a decision on whether induction is a good choice for you.
How does each vaginal exam affect the Bishop score?
Here are Wikipedia’s descriptions for each of the Bishop score components:
The position of the cervix changes with your menstrual cycle and also becomes more anterior as labor becomes closer.
Consistency In women who are in their first pregnancy the cervix is typically tougher and resistant to stretching, much like a balloon that has not been previously inflated. With subsequent vaginal deliveries, the cervix becomes less rigid and allows for easier dilation at term.
Effacement translates to how ’thin’ your cervix is. The cervix is normally approximately three centimeters long, as you prepare for labor and labor continues your cervix will efface till it is fully effaced.
Dilation is a measure of how open the cervical opening is. It is usually the most important indicator of progression through the first stage of labor and the most important factor in the Bishop score.
The fetal station describes the position of the baby’s head in relation to the distance from the ischial spines, which are approximately 3-4 centimeters inside the vagina and are not usually felt. Health professionals visualize where these spines are and use them as a reference point. Negative numbers indicate that the head is further inside than the ischial spines and positive numbers show that the head is below the level of the ischial spines.
The Bishop score is just one of a few indicators of how likely you are to need a medical induction and how likely that induction is to succeed. Many women have low Bishop scores and go on to have a beautiful, natural birth after induction.
We also need to take into consideration the baby’s position. It’s very likely that it's the baby's position that is responsible for a low Bishop score when a woman is nearing the 42-week mark. Posterior positioning doesn’t allow the baby to put the right kind of pressure on the cervix, the kind of pressure that helps thin and dilate. This is where natural induction techniques that focus on getting babies into position are helpful.
Another important thing to keep in mind is that women efface and dilate at different rates and speeds. One woman may be 50% effaced and 1-2cm dilated 3 weeks before labor while another doesn’t start either until active labor begins.
The takeaway should be that the Bishop score can help you make the best decisions for you and your baby. If you and your baby are healthy, you will want to be sure to have a high Bishop score before considering induction. If you have a high Bishop score and are healthy you may want to try induction or you may want to wait since spontaneous birth is likely around the corner.
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