Cervical ripening
Induction of labour
Bishop score

How is the Bishop score used during labour induction?

July 24, 2024
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Contributors
Monica Myron, MSN, RNC-OB
Certified nurse

Monica Myron, MSN, RNC-OB has spent more than 25 years supporting women and families through pregnancy, birth, and postpartum recovery. She writes practical, evidence-based content to help parents make informed decisions. Full profile →

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Jan Waclav, MD
Clinical & Medical Affairs Director

Physician and Clinical & Medical Affairs Director with 30+ years of experience in clinical research, medical affairs, and evidence-based healthcare. Jan is certified in Anesthesia and Intensive Care Medicine and has held senior medical leadership roles at MEDICEM Technology, SOTIO, GlaxoSmithKline, and AstraZeneca.

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Key takeaways

A low Bishop score does not necessarily mean labour induction cannot move forward. Cervical ripening can help prepare the cervix for labour, but every woman responds differently. Some women may require more than one attempt of cervical ripening before labour induction can begin.

  • A low Bishop score may indicate that the cervix is not yet ready for labour induction and further cervical ripening may be needed.
  • The Bishop score can increase over time as the cervix becomes more favourable for labour.
  • Cervical ripening may involve more than one attempt before labour induction can begin.

The Bishop score is a basic assessment tool—your practitioner will use it to calculate how ready your cervix is for labour induction. Would you like to know more? Check the full article on Bishop score. But for now let´s take a look at how the whole process may go in real life.

Please note: The situation below is a theoretical example. Each process is unique, and practices vary among states and even hospitals. Your experience may be different.

Bishop score in real life

A first-time mum, overdue by 10 days, needs to have labour induction. Today, her cervix measures at 1 cm but is still posterior, 0% effaced, and firm. The baby is at -3 station. With a Bishop score of 1, her practitioner inserts DILAPAN-S rods in her cervix to start the cervical ripening.

After her appointment, the mum enjoys lunch with some friends before returning home for an afternoon nap. Later, after dinner, she takes an evening walk. Following her practitioner’s advice, she plans to head to the hospital around 11 p.m. for a re-evaluation.

Upon her arrival, the DILAPAN-S rods are removed. To her excitement, she discovers that she is now: 3 cm dilated, 40% effaced, and with a medium softness—however, the cervix is still posterior and the baby is -3 station. This gives her a Bishop score of 4, which is a great progress! But she needs just a little more time.

After a chat with her practitioner, they agree to proceed with another round of DILAPAN-S.

After the rods are inserted, she takes a shower and settles in for a well-deserved night’s rest before the morning reassessment of her cervix. Throughout the night, she was able to rest on and off with some mild cramps and a little bit of bloody show.

When her practitioner checks her cervix in the morning, they find that she is now: 4 cm, 50% effaced, the cervix is soft, in the middle position and the baby has descended to -1 station. With a Bishop score of 8, her body is ready to start the induction and continue the journey towards a natural birth.

Monica Myron
- certified registered nurse

Disclaimer: This blog post is for informational purposes only and should not be considered medical advice. Always consult with your healthcare provider to address your individual needs and concerns.

FAQs
What is the Bishop score?

The Bishop score is a tool used by healthcare providers to assess how ready the cervix is for labour or labour induction. It evaluates five factors, including cervical dilation, effacement, consistency, position of the cervix and the baby's station. It helps clinicians determine whether labour induction can begin or if cervical ripening may be needed first.

What is cervical ripening?

Cervical ripening is the natural process of preparing the cervix for labour. During this process, the cervix becomes softer, thinner and begins to open. If labour induction is needed and the cervix is not yet ready, assisted cervical ripening methods may be used to support these changes.

What are the cervical ripening methods?

Cervical ripening can be achieved using either mechanical or pharmacological methods. Non-hormonal methods, such as DILAPAN-S, help prepare the cervix mechanically, while pharmacological methods use medication to stimulate cervical changes. In recent years, mechanical methods have become increasingly popular due to their favourable safety profile and comparable effectiveness.

Contributors
Monica Myron, MSN, RNC-OB
Certified nurse

Monica Myron, MSN, RNC-OB has spent more than 25 years supporting women and families through pregnancy, birth, and postpartum recovery. She writes practical, evidence-based content to help parents make informed decisions. Full profile →

Show more
Jan Waclav, MD
Clinical & Medical Affairs Director

Physician and Clinical & Medical Affairs Director with 30+ years of experience in clinical research, medical affairs, and evidence-based healthcare. Jan is certified in Anesthesia and Intensive Care Medicine and has held senior medical leadership roles at MEDICEM Technology, SOTIO, GlaxoSmithKline, and AstraZeneca.

Show more
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