As strange as it may seem, your cervix can get an official assessment if your labor is induced. (I bet you’ve never thought of that before!) Often, your doctor or midwife will assess your cervix using something called a Bishop score to tell how ready your body is for labor. It’s a bit subjective, but simple and quite effective.

“The Bishop score is very helpful in properly managing induction,” says Shannon Smith, MD, an ob/gyn at the Brigham Faulkner Ob/Gyn AssociatesOpens a new window in Boston and a member of the BabyCenter Medical Advisory Board. “I document the Bishop results for all my patients when we plan induction.”

What is the Bishop score?

The Bishop score is a number your doctor or midwife uses to assess whether your cervix is ​​ready for induction, based on how open, soft and thin it is – its dilation and effacement.

It also takes into account the consistency of your cervix, its position and where your baby’s head is in your pelvis. Sometimes called the cervical score or the pelvic score, it is named after Edward Bishop, who created it in 1964.

Using sterile gloves and vaginal lubricant, your doctor will feel your cervix and rate it based on five factors. They will then use the result to determine how to proceed with your induction. You may be ready for Pitocin to start contractions, or you may need a “cervical ripening” technique (such as prostaglandins or a Foley bulb) to prepare your cervix.

How to calculate the Bishop score

Your doctor will calculate a total Bishop score between zero and 13. The higher the number, the better, which means it will be easier to go into labor with an induction and the more likely you will have a successful vaginal birth.

Here are the factors your provider will look at and how they will calculate your score:

Dilation

How dilated (open) is your cervix, based on the diameter of the cervical opening?

0 cm = 0 points

1 – 2 cm = 1 point

3 – 4 cm = 2 points

6 cm or more = 3 points

Deletion

How thin is your cervix? This number is added up as a percentage, compared to the cervix that is not in labor.

0% – 30% = 0 points

40% – 50% = 1 point

60% – 70% = 2 points

80% or higher = 3 points

Station

Where does your baby’s head sit? This number is calculated based on where the head is in relation to your ischial spines (the bony projections of the lower pelvis). If the head is above the ischial spines, the score will be a negative number, from -1 to -3, with -3 being highest in the pelvis. If it is on the ischial spines, it is considered 0. And below the ischial spines, it will be a positive number from 1 to 3, with 3 being the lowest in the pelvis.

Minus 3 = 0 points

Minus 2 = 1 point

Minus 1 or 0 = 2 points

1 or 2 = 3 points

The position of the cervix

Where is your cervix in relation to your baby’s head and pelvis? It moves forward (forward) as labor approaches.

Posterior position (toward the back) = 0 points

Middle position (centered) = 1 point

Front position (toward the front) = 2 points

Consistency

How does your cervix feel? Is it firm, hard and rubbery, like the tip of your nose? Soft and mushy, like your lips? Or somewhere in between?

Company = 0 points

Medium = 1 point

Soft = 2 points

Sometimes your provider will add or subtract points from your total score based on other factors. They may add points if this is not your first baby, for example, or deduct points if you are more than 40 weeks pregnant.

What is a simplified Bishop score?

Some providers use a shortened, simplified version of the Bishop score. A studyOpens a new window of more than 5,000 first-time women found that the simplified version was just as good at predicting successful induction.

The abbreviated Bishop score takes into account only dilatation, effusion, and station, each of which is worth 0 to 3 points (scored the same as the original Bishop score). A total score greater than 5 is favorable.

What does the Bishop score mean for labor and delivery?

Despite what you may have heard, the Bishop score cannot tell you that labor is about to start on its own. Or, as dr. Smith cautions, “The Bishop score does not predict labor.”

One woman may have a closed cervix while another is 2 cm dilated, she explains, and the woman with a closed cervix will give birth first. “I really wish we had something to help women get closer to their expected delivery time, but we still don’t,” says Dr. Smith.

For an introduction, the higher your Bishop score, the better. If your cervix is ​​”immature” (not yet ready for pitocin), then the chances of a vaginal birth are less and cervical ripening is recommended, he says American College of Obstetricians and GynecologistsOpens a new window.

“If your score is 8 or higher, your chances of having a vaginal birth are the same with pitocin induction as you would be if you went into spontaneous labor,” explains Dr. Smith. “If your score is less than 8, then cervical ripening will be necessary to properly manage induction and maximize the chances of a vaginal delivery.”

After using the cervical ripening technique, your provider will do another Bishop score to assess your progress. The process may take some time.

“My induction started really slow and easy with a Foley bulb and some Cervidil (cervical ripening gel) and eventually we progressed to Pitocin and finally broke my water,” says BabyCenter community member IVFwarriorbabe at Pregnancy group. “It was a slow process for me. It was about 26 hours from the start of the induction to the delivery.”

Keep in mind that the Bishop score is only one tool your doctor will use to determine if you are ready for an induction. They will also take into account factors such as your health and how your baby is doing.

The Bishop score does not predict labor. I really wish we had something that could help women get closer to their expected delivery time, but we still don’t.

– Obstetrician Shannon Smith, MD

Will I know my Bishop score?

You may not know unless you ask. Your Bishop score is not something you need to monitor or be overly concerned about during your induction.

That said, feel free to ask your doctor how they plan to proceed with your induction and what information the result has given you.

For example, if your cervix isn’t dilated or effaced and the baby is still above your ischial bones, your doctor may suggest waiting to induce labor if it’s safe to do so. Or they may advise you to use medication or a Foley catheter to help ripen your cervix if your baby is far down in the pelvis and you are past your due date.