Understanding Your Bishop Score

Induced Birth Pregnancy Bishop Score.png

Being induced is definitely high on the list of questions and concerns during pregnancy, and today we wanted to shed some light on a tool used when considering induction: the Bishop Score! We have talked in the past about inductions, and what sort of questions to ask if you are considering or being offered one. We have also shared a positive induction story, to take away some of the fear- because we all know someone with a scary story to share!

In reality, being induced doesn't have to be scary. It is a very common intervention. and many women are still able to achieve a happy, positive birth experience, even with Pitocin. One of the ways that you cane make it a calm experience is to ask questions, and make sure you know what to expect!

What Is the Bishop Score?

The Bishop Score is an assessment tool that your doctor or midwife might use when deciding when or how to start an induction of labor. It takes information about your cervix and position of your baby, and puts that together to try to make a prediction about how successful an induction might be. It is important to know that it is an assessment or prediction, it is not crystal ball telling you for sure what will happen! Babies surprise us every single day.

How Is It Scored?

There are 5 factors considered when your doctor or midwife calculates your Bishop Score:

  1. How soft is the cervix?
  2. What position is the cervix in?
  3. How dilated is the cervix?
  4. How effaced is the cervix?
  5. What station is the baby's head at in relationship to the pelvis?

You can see how each of these components is scored on scale of 0-2 or 0-3 below in the infographic. The higher your total number after scoring each individual category, the more "favorable" or ripe your cervix is for induction. In addition to these five measures, you may gain or lose an extra point for certain things like pre-eclampsia, if your water is broken, or how far along you are. The chart below just shows the basic scoring system, without taking into account these other individual factors.

Bishop Score Induction Labor

What If My Bishop Score Is Low?

Don't panic! There are things that your doctor may do or recommend to help increase the favorability of your cervix (sounds funny, right!?) Cervidil or cytotec are medications that can be used to soften and efface your cervix (often while you sleep!) A foley bulb catheter or Cook's catheter can be used to increase your dilation.

In the end, keep in mind that this is just a guess anyway. No one knows exactly how your cervix and body and baby will respond to an induction. As doulas, we have seen inductions take a few days and then kick suddenly into high gear, and we have also seen people with a low Bishop Score go into labor and have their baby less than 24 hours later!

What Happens If an Induction Doesn't Work?

This is a good question to ask your care provider when you are considering an induction of labor. Depending on the individual circumstances, there are usually four potential options:

  1. Continue to try more rounds of medication to try to kick labor into gear.
  2. Proceed to a cesarean birth.
  3. Take a some hours off, and try again with the medications after a break.
  4. If mom and baby are still healthy, stop the induction, and go home to wait for labor to start or try again later.

The best next step will depend on a lot of factors, including your care provider's comfort level with the options, how you and your baby are doing, and the reason you were being induced in the first place.