Bishop Score Basics: Understanding This Decision-Making Tool

A Bishop score is a scoring system that uses information obtained through a cervical exam. You end up with a total score that is based on the following factors:

• Dilation
• Effacement
• Station
• Consistency
• Position

We’ll talk more in a second about what these terms mean and how points are assigned.

But, first, I want to get more into cervical exams. These are commonly done during the labor to check your progress (although this isn’t the only way). Cervical exams may also be offered at your prenatal visits near the end of pregnancy. Your cervix may start to change in these final weeks, though this isn’t always the case.

📝 Note: The results of your cervical exam can’t predict when labor will spontaneously begin. And any major change won’t happen until you’re in labor.

Cervical exams can feel invasive and increase the risk of infection, especially if your bag of waters is broken. It can also be stressful when you’re eager for labor to start to find out your cervix hasn’t really changed yet.

Cervical exams should not happen without your informed consent. It’s important to be clear on why a cervical exam is being offered or recommended so that you can make an informed decision.

The information provided by a cervical exam can be helpful when decisions about labor induction need to be made. Labor induction is the process of using medical or mechanical methods to stimulate uterine contractions and initiate labor before it begins on its own. Read on to see how this information is used to calculate your Bishop score and how this score can be used in decision-making.

Calculating Your Score

The chart below shows how points are assigned, based on the results of the exam.

📝 Note: Your Bishop score would be calculated by your care provider after a cervical exam, if decisions about induction need to be made. This isn’t something you will have to calculate. But, it can he helpful to understand how it’s calculated, for learning purposes.

Dilation

The cervix has to fully open before the second stage of labor/ pushing begins. Cervical dilation is measured from 0-10 centimeters and is an estimate of how open the cervix is.

• 0 cm ➡️ 0 points
• 1-2 cm ➡️ 1 point
• 3-4 cm ➡️ 2 points
• 5+ cm ➡️ 3 points

Effacement

The cervix also has to thin and shorten before the second stage of labor/ pushing begins. Effacement is measured as a percentage. 0% means there is no change yet, while 100% means the cervix is fully thinned out.

• 0-30% ➡️ 0 points
• 40-50% ➡️ 1 point
• 60-70% ➡️ 2 points
• 80%+ ➡️ 3 points

Station

Fetal station is a measurement of where your baby’s presenting part is located in your pelvis, specifically in reference to the ischial spines (bony protrusions). A baby is considered “engaged” in the pelvis when it reaches 0 station. This can happen before or during labor. As labor progresses, your baby descends further into the pelvis.

• -3 ➡️ 0 points
• -2 ➡️ 1 point
• -1, 0 ➡️ 2 points
• +1, +2 ➡️ 3 points

Consistency

A firm cervix feels like the tip of your nose and will start to soften before and during labor.

• Firm ➡️ 0 points
• Medium ➡️ 1 point
• Soft ➡️ 2 points

Position

During pregnancy, the cervix points more toward the back of the body. Before and during labor, the position of the cervical opening will start to change to pointing more toward the front of the body.

• Posterior ➡️ 0 points
• Mid ➡️ 1 point
• Anterior ➡️ 2 points

Your Total Score

Your total number of points will then be added up:

• 8 or more points: Your cervix is favorable or “ripe”, and a vaginal delivery is likely if an induction is needed.
• 5 or less points: Your cervix is not favorable or “ripe”, and a vaginal delivery is less likely if an induction is needed. Medications can also be used to prepare or “ripen” your cervix for induction. This process can take time, which is an important consideration. A cesarean section may be necessary in more urgent situations, where waiting for medication to ripen the cervix would take too much time.

A score of 6 or 7 isn’t great at predicting the outcome of an induction. A discussion with your care provider about your options would be the next step, in this case.

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Hopefully you now have a better understanding of a Bishop score and how it can be used in decision-making.

The awesome illustrations in this post were created by The Educated Birth.

A Bishop score calculator is one of the tools included in my Proactive Pregnancy Planner. Click the button below to check it out!

Learn More About the Proactive Pregnancy Planner