Teaching the Bishop Score

A multitude of tests, evaluations, and decisions occur during pregnancy. As a childbirth educator, it's important to help your clients understand what to expect, especially in the weeks leading up to labor. Providing clear, up-to-date information empowers them to make informed choices that fit their needs.

One evaluation that your clients may encounter is the Bishop score. Developed in 1964 by Edward Bishop, this scoring system is still used today to evaluate whether labor induction is likely to be successful.

In this article, we’ll review the basics of the Bishop score, why it’s important for your clients to understand, and tips for teaching it effectively.

What is the Bishop Score?

The Bishop score is a cervical assessment system used by health care providers to predict whether labor induction will be successful. It looks at aspects of the birthing woman’s cervix and her baby’s position, including:

• Dilation and effacement (opening and thinning)
• The cervix's position (anterior or posterior)
• The consistency (softening) of the cervix
• Where the fetus's head is stationed (how high or low) in the pelvis

Each of these factors is given a score, ranging from 0 to 3. Lower numbers indicate that the pregnant woman's body is not favorable for induction, while higher numbers are more favorable. The number range can be broken down into several categories:

• 8 points or higher: Induction will most likely be successful. There is also a high probability that labor will soon begin on its own.


• 6–7 points: It could go either way as to whether labor induction may be successful or fail to get labor going.


• 5 points or lower: Labor induction will probably fail. Natural labor is also not likely to start soon.

What Do Expectant Parents Need to Know About the Bishop Score?

The Bishop score assessment is used when induction of labor is being considered as it can help to determine if induction is likely to be successful. It is only one factor to consider in a conversation about inducing labor. Determining when and how to try to start labor artificially can be a complex and multifaceted process. Research is mixed on whether or not the Bishop score is an effective way to determine if labor induction will work. Still, it’s often used by health care providers. Sometimes it is combined with a pelvic ultrasound or a transvaginal ultrasound to get more information.

Health care providers do not always volunteer information about the Bishop score to their patients. They may not even mention that they are using it. However, educating your clients about it, and encouraging them to ask about their score before agreeing to induction, gives expectant parents valuable information when deciding what to do, especially when taken together with other data. Inducing labor in a mother when her body is not ready increases her risk of complications such as a failed induction, increased stress on both mother and baby, and additional interventions, including cesarean sections.

Clients should understand that calculating the Bishop score involves a digital (finger) exam of the cervix by their health care provider. At times, a mother may bleed and experience discomfort after a cervical exam. An exam also increases the risk of the amniotic membrane rupturing (the water breaking).

You can emphasize that if a pregnant mother doesn’t feel comfortable with cervical exams for any reason, including a history of sexual abuse, they should share this information with their health care provider.

Ways to Teach about the Bishop Score

Teaching your clients about the Bishop score is a great springboard for discussing many topics related to pregnancy and childbirth. First, it’s a great way to discuss anatomy and help mothers get more connected with different body parts involved in childbirth. To make these connections:

• Use visual aids (posters, videos, or PowerPoints) to show students where the cervix is and how it changes leading up to labor. Starting with a general overview of anatomy lays the groundwork for a more detailed discussion on cervical changes as labor approaches. Some useful tools include the Anatomy of Pregnancy and Physical Changes in Labor posters or the Preparing for Birth PowerPoint.


• Use hands-on tools to illustrate fetal positioning and fetal stations, such as a model pelvis and demo doll.


• Cover the mechanics and process of labor and birth first, then discuss the complex process of labor induction. The Preparing for Birth guide book includes information on all of the common methods of induction as well as considerations for managing an induction. 

Along with connecting to big picture concepts, teaching clients about the Bishop score provides an excellent opportunity to emphasize self-advocacy, understanding different medical procedures, reasons to avoid unnecessary interventions, and the idea that birth is unpredictable and many factors impact birth outcomes. Combining the Birth Choices and Preparing for Birth parent guide books in your childbirth classes will give your clients a comprehensive understanding of what to expect, how to establish priorities, and ways to engage in healthy communication throughout the process.

As you teach the Bishop score, consider how you can prompt critical thought and discussion. Use these questions in your conversation with students:

• Has your health care provider discussed how they will determine whether or not to recommend labor induction?


• What are your concerns about medical interventions during childbirth?


• How can your baby’s position affect how and when you go into labor?
• Do you have concerns about asking your health care provider about various tests and procedures they are doing?


• What are some ways you can advocate for yourself (or have others do so) when childbirth interventions are mentioned by your health care provider before and during labor?

Takeaways

The Bishop score is just one piece of the puzzle when it comes to whether or not induction during childbirth is necessary or will be effective. But it’s something all birthing women should know about. Teaching about the Bishop score also underlines the idea that, whenever possible, careful assessments should be done before interventions are utilized in childbirth.

Wendy Wisner, Freelance Writer and Lactation Consultant (IBCLC)

Disclaimer: All content provided is for educational and informational purposes only, and should not be construed as medical advice. These statements are not intended to diagnose, treat, cure or prevent any disease and no alterations in exercise should be taken solely on the contents of this website. Consult your physician on any topics regarding your health and fitness. Plumtree Baby, LLC does not assume any liability for the information contained herein, be it direct, indirect, consequential, special, exemplary or other damages.

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References

Bishop Score. The Cleveland Clinic.

Induction of Labor at 39 Weeks. American College of Obstetricians and Gynecologists.

Wormer KC, Bauer A, Williford AE. Bishop Score. [Updated 2024 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470368/