Everything you need to know about Bishop’s Scores
What is it?
The Bishop’s score is a method used to assess how ready your body is for labor. The higher the score, the more likely an induction will be successful. If your bishop’s score is low and you decide to proceed with an induction, you will likely start with a cervical softener instead of Pitocin (a contraction stimulator). For more information on how a bishop’s score is used to determine induction method, see my blog post about inductions.
A cervical check is required to determine your bishop’s score. It takes into account five factors, each scored on a scale of 0 to 2, and the scores are then added together to give a total score out of 10. The factors included in the Bishop’s score are:
Dilation: How open the cervix is. Scored as 0 if closed, 1 if 1-2 cm dilated, and 2 if 3 cm or more dilated.Effacement: How thin the cervix is. Scored as 0 if less than 50% effaced, 1 if 50-70% effaced, and 2 if more than 70% effaced.
Consistency of Cervix: How soft or firm the cervix feels. Scored as 0 if firm (like your forehead), 1 if medium, and 2 if soft (like your lips).
Cervical Position: Which direction the cervix is facing. Scored as 0 if posterior (facing towards your back), 1 if mid-position, and 2 if anterior (facing towards your front).
Station: The position of the baby’s head in relation to the mother’s pelvis. Scored as 0 if above the ischial spines (-1, -2, -3 station), 1 if at the level of the ischial spines (0 station), and 2 if below the ischial spines (+1, +2, +3 station).
How is a bishop’s score used?
A score of 8 or higher is generally considered favorable. This means that your body is ready for labor and an induction will likely just kickstart the process early. The induction would likely be done using Pitocin or breaking your water.
A score of 6 or lower would indicate that your body needs more time to go into labor naturally, so a Foley Bulb or medications such as Cervidil would be used first. Pitocin may still be recommended after the Foley Bulb or Cervidil is used if contractions do not start or the contractions subside once the Foley Bulb or Cervidil is removed.
Read my blog post about inductions to learn more about how and when each medication might be recommended.
It is important to note that cervical checks are subjective. 2 people doing a cervical check on the same pregnant woman minutes apart, can give a different bishop’s score and even a different dilation! If you are having an induction, it is best to request the same person perform all cervical checks for the duration of their shift to help eliminate this variation.
Risks of Cervical Checks
Cervical checks come with a few risks:
Risk of Infection – This is the biggest risk to both you, baby, and a complication free labor. If you develop an infection, you will likely spike a fever and either be put on antibiotics or offered a c-section.
Pain – Many women find cervical checks uncomfortable or even painful.
Break Waters – The pressure of the cervical check may cause your waters to break. Especially if your bag of waters is thin. However it is definitely more common with membrane sweeps.
Stall Labor – If you are having contractions already, getting a cervical check may put your body into fight or flight mode causing your contractions to stop
You can decline a cervical check at any stage of labor, whether you are induced or not.
