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Bishop Score: What It Is and Why It’s Important

Nearing the end of your third trimester is like running a marathon (that felt like an eternity, might we add) and finally being able to see the finish line. To help prepare you in crossing the finish of labor and delivery, your doctor or midwife may begin discussing the Bishop Score—a criterion used to measure how ready your cervix is for childbirth.

Keep reading for a breakdown of the meaning of the Bishop score, how you’re tested for the score, and what your final results mean.

What is the Bishop Score?

The Bishop score is a scoring system that helps assess the ripeness of your cervix for a vaginal birth. During pregnancy, the cervix is closed and firm to keep the baby in the uterus. Towards the end of pregnancy and once labor begins, the cervix becomes soft and thin and will then dilate wide enough for the baby’s passage.

Health care professionals also use the score to determine expecting mothers’ likelihood of success with labor induction for a vaginal delivery—this can help rule out the need for a C-section.

Named after Dr. Edward Bishop, who published the scoring system in 1964, the scale reviews five specific areas to calculate a total score from zero to 13. Based upon that sum, a pregnant mama is either ready for labor or not yet there, allowing their healthcare provider to decide how to proceed with delivery.

How is Your Score Determined?

During your final trimester of pregnancy, between 38 and 41 weeks, your healthcare provider may conduct a vaginal exam to determine your Bishop Score. To generate a final number and assess the readiness of your cervix, they will need to evaluate five different metrics via a physical exam and ultrasound:

1. Cervical consistency

Is your cervix hard like the tip of a nose or soft like butter? As your body prepares for labor, it is natural for the cervix to soften and become pliable so that it can stretch itself when it’s time for childbirth.

2. Cervical dilation

Your healthcare provider will complete a physical evaluation by inserting two fingers in the vagina to review how wide the cervix has opened (or dilated) and measure it in centimeters.

During labor, your contractions will help to open your cervix more. But it is important that the area is already opening. In order to push during a vaginal delivery, the cervix must be close to 10 centimeters dilated.

3. Cervical effacement

Not only will your cervix change its texture in preparation for delivery, but it will also begin to shorten in size (efface). In the early stages of your pregnancy, your cervix is the longest it will be to help protect your baby by creating a long distance from the outside of your body. Close to 20 to 24 weeks of gestation, your average cervical length will be about 30 to 40 millimeters. And as you near delivery, it’ll be at its shortest of around 25 millimeters.

The cervical effacement also tests how thick or thin your cervix is. If it’s as thin as paper, it’s ready for delivery.

4. Cervical position

As you near the end of your pregnancy, your cervix even switches its position, lowering itself from posterior to anterior down into the pelvis to make way for your newborn. The lower it is, the better your baby’s head can descend.

5. Fetal station

Fetal station refers to the location of the lower part of your infant’s body (the head, buttocks, feet, or shoulder!) in relation to your pelvis. Early in your pregnancy, your baby is positioned high up in the birth canal (-5 station). With time, their head will become level with your ischial spines, a.k.a. bone points located in the narrowest part of your pelvis.

Usually, two weeks before your expected delivery date, your baby will lower into the birth canal. Just before birth, their head will fill the vaginal opening (0 station).

What Does Your Score Mean?

With the final results of your examination, your healthcare provider will tally up your points into a score that ranges between zero to 13. The higher your score is, the more likely you’ll have a vaginal delivery with induction. The lower the score, though, the lower the chance you’ll have of a successful induction.

  • 8 or higher: Hooray! A Bishop score above eight means you’ll likely go into labor soon naturally. If your healthcare provider deems induction necessary, you also have a better chance of this process being successful and having a vaginal birth.
  • 6 to 7 points: A total in this range can go one way or the other. Being in the middle of the scale doesn’t clearly indicate if induction will or will not be successful.
  • 5 or lower: If you receive a low score, don’t freak out. While a lower number signifies that induction will less likely lead to vaginal delivery, it means that your healthcare provider will look to other approaches to help prepare your cervix and additional options for childbirth, such as a C-section.

Whether you receive a high Bishop score or a lower total, remember that your health care professional is keeping your and your baby’s best interest in mind. Don’t worry yourself sick. Instead, focus on the happy experiences to come, like the beauty of childbirth, however it happens for you!

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