Bishop Score

What is a Bishop score?

Bishop score is a calculation used to predict how close you are to labor. Your healthcare provider will examine your cervix and determine your Bishop score based on changes in your cervix and the position of your baby’s head. Your final score can help determine if induction will lead to a successful vaginal birth. Your score can range from zero to 13, with zero meaning you’re not ready for induction and 13 indicating a better chance for successful induction.

Your cervix connects your birth canal to your uterus. It has a small opening in the center — almost like a donut. As your body prepares for labor and delivery, your cervix softens, thins and opens up. This can happen several weeks or several days before your baby is born. Your Bishop score rates how ready your cervix is for labor by looking at how it has changed.

It’s sometimes called a pelvic score or a cervix score.

What does Bishop score predict?

Bishop score helps predict how ready your body is for labor. It’s a specific set of criteria that healthcare providers use. By looking at the changes in your cervix and the position of your baby’s head, your healthcare provider can estimate if inducing labor will be successful. For those wishing to deliver vaginally, this score can help determine if inducing labor will lead to vaginal delivery.

When is Bishop score used?

Healthcare providers don’t typically calculate your Bishop score until you are past 40 weeks pregnant. This is because induction isn’t usually considered until you reach post-term (41 or 42 weeks in pregnancy). Your healthcare provider may use Bishop score earlier than 40 weeks if they feel it’s necessary.

Certain medical conditions and the overall health of you and your baby may limit the use of the Bishop score. For example, if you have placenta previa, a Cesarean delivery (C-section) may be safer. Or if your membranes have ruptured prematurely, performing a pelvic exam of the cervix could be risky.

How is Bishop score calculated?

Your healthcare provider uses these five factors to calculate your Bishop score:

• Dilation of the cervix: Dilation refers to how open your cervix is. A fully dilated cervix is about 10 centimeters. Dilation is measured with fingers, then translated to centimeters.
• Effacement of the cervix: Effacement means how thin or short your cervix is. Fully effaced (or 100% effaced) means your cervix is “paper-thin.”
• Consistency of the cervix: This refers to how tough your cervix is. A softer, more flexible cervix is more likely to dilate. Think of it as comparing the hardness of the tip of your nose to the softness of your lips.
• Position of the cervix: The position of your cervix moves closer to your birth canal as labor nears. This is referred to as being anterior. If your position is posterior, you are further away from labor.
• Fetal position (or fetal station): This measures the position of your baby’s head in relation to the ischial spine (a place in your pelvis). Healthcare providers give a rating based on if the head is above or below that point in the pelvis. A positive number means your baby’s head has descended into the birth canal, and a negative number means your baby’s head is still high.

Each factor is given a score. Then, the five individual scores are added to get your final Bishop score. A higher Bishop score means inducing labor is likely to be successful.

Bishop score chart

Each factor in the Bishop score has either three or four options related to how favorable the cervix is. A favorable cervix means it’s ready for labor.

The following chart is an example of Bishop score:

For example, if you’re 4 centimeters dilated (two points), with an anterior cervical position (two points), 50% effaced (one point), a firm cervix (zero points) and a fetal position of zero (two points), your Bishop score would be seven.

Some healthcare providers will add points to your Bishop score if you have preeclampsia or have had previous vaginal births because a successful induction is more likely. Points are deducted for factors such as being post-term (greater than 40 weeks pregnant) or having no prior vaginal deliveries. Not every healthcare provider adds or subtracts points for these factors.

How does my doctor measure my Bishop score?

Your healthcare provider calculates your score after a physical exam of your cervix. This is called a digital exam because gloved fingers are used. The location of your baby’s head can either be seen on an ultrasound or felt by placing their hands on your abdomen. Your provider will go through each factor and assign it a score based on their exam.

If you have placenta previa or premature rupture of your membranes, your healthcare provider will probably avoid a physical exam as it could disrupt your cervix and cause complications.

What should I expect when my doctor examines my vagina?

You may have some discomfort during a physical exam of your cervix. Your healthcare provider will ask you to lay back on an exam table with your feet in stirrups. Then, they will insert a gloved finger into your vagina to feel your cervix.

What does my Bishop score mean?

Your points for each of the five factors are added to give you a final score. The score ranges mean:

• Eight or more points: Your labor is likely to begin soon. If you were to be induced, successful vaginal delivery is likely.
• Six to seven points: Induction may or may not be successful. It’s a point where your healthcare provider would need to make a judgment call.
• Five and fewer points: Your body isn’t prepared for labor and it’s unlikely to start naturally.

It’s important to know that your Bishop score is just one indicator of how likely you are to need an induction. It’s meant to help you and your healthcare provider make the best decision about your labor and delivery based on your pregnancy and medical history. Some people have low Bishop scores and have successful vaginal births after inductions. Conversely, some people with high Bishop scores have unsuccessful inductions.

What is a good Bishop score?

A higher score means that labor is closer and that induction has a good chance of being successful. A good Bishop score is eight or higher.

When does a Bishop score mean induction is necessary?

Inducing labor is based on several factors. Induction is typically necessary when certain medical conditions are present or when your healthcare provider feels it’s unsafe to wait for labor to progress naturally. Bishop score is a tool healthcare providers use to help them make decisions, but it isn’t the only indicator for an induction.

What does a Bishop score of 10 mean?

A Bishop score of 10 means you may go into labor soon. It also means that if you were to be induced, a successful vaginal delivery is highly likely.

Why is it called Bishop score?

The Bishop score is named after Edward Bishop. He created the score in 1964 to help predict the success of inducing labor using five criteria.

What is a simplified Bishop score?

A simplified Bishop score means your healthcare provider is considering three factors instead of five. The three factors used in the simplified Bishop score are dilation, effacement and fetal station. Each is scored from zero to three points. A score of more than five is considered high in the modified version (meaning an induction is likely to be successful).

When is labor induced?

Labor is induced for a variety of reasons. It may be suggested if your pregnancy lasts longer than 41 or 42 weeks. This is because, after 42 weeks of pregnancy, the risk for complications increases and your placenta may not work as well. Labor is also induced when certain medical conditions are present in either mother or baby or when your healthcare provider feels it’s necessary.

A note from Cleveland Clinic

Your Bishop score can help you and your healthcare provider determine if inducing labor will be successful. Talk to your healthcare provider to make sure you understand the risks and benefits of inducing labor or if it will work for you. Ultimately, you and your healthcare provider have the shared goal of keeping you and your baby healthy.