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BISHOP Scores & Inductions

Hello Mama,

I want to dive into BISHOP scores and why as a birthworker we encourage you ask questions and understand yours! When a mom is faced with the possibility of an induction there are a lot of questions to ask, but two are my most important:

  • Is this induction medically necessary and why?

  • What is my BISHOP score?


These questions will help you navigate the decision on when and if you'll get induced.


If your goal is to have a vaginal birth it's important to look at the statistics on how being induced can affect this goal. As a mother you are in charge of the process & although plans can change through any pregnancy & birth process I want YOU to feel empowered and firm in your decisions.


So lets get into it!


What is a BISHOP score? 


The Bishop Score is a clinical assessment used to evaluate readiness of labor. It plays a crucial role in determining whether induction of labor is necessary and likely to be successful. It includes a scoring system consisting of five factors: cervical dilation, effacement, consistency, position, and the station of the baby. Each factor is scored between 1-3, with a total score ranging from 0 to 13. Typically anything over an 8 indicates chances of a more successful induction of labor. 


Components of the Bishop Score:


  • Cervical Dilation: Measures how open the cervix is, ranging from closed (0 cm) to fully dilated (10 cm).



  • Cervical Effacement: Assesses the thinning of the cervix, from 0% (no effacement) to 100% (fully effaced).



  • Cervical Consistency: Evaluates the firmness of the cervix, from firm (0 points) to soft (2 points).

  • Cervical Position: Looks at the position of the cervix, whether it is posterior (toward the back) or anterior (toward the front).



  • Fetal Station: Indicates the position of the fetal head in relation to the ischial spines of the pelvis, ranging from -3 (high) to +3 (crowning).






Importance of the Bishop Score 


The Bishop Score is significant for several reasons:


1. Predicting Success of Induction: A higher Bishop Score suggests a more favorable cervix, increasing the likelihood of a successful induction. Studies show that scores of 8 or more are associated with higher rates of vaginal delivery after induction, whereas lower scores indicate a greater chance of cesarean delivery.


2. Guiding Clinical Decisions: The score helps healthcare providers make informed decisions about the timing and methods of induction. For instance, a low score might prompt the use of cervical ripening agents, while a high score may allow for immediate induction.


3. Reducing Maternal and Fetal Risks: By accurately assessing cervical readiness, the Bishop Score can help reduce unnecessary interventions, minimizing risks for both mother and baby.


Evidence Supporting the Bishop Score


Research has consistently supported the utility of the Bishop Score. Multiple studies, linked below found that a Bishop Score of 6 or less was linked to a higher likelihood of cesarean delivery and longer labor. Conversely, scores above 8 correlated with shorter labors and higher vaginal delivery rates.


In summary, the Bishop Score is an essential tool. Any mother being faced with an induction should know the full risk and benefits of her individual situation.  Understanding and utilizing this scoring system can significantly influence the outcome of an induction and thus affect the birthing persons experience. 



Evidence:



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