What Is the Bishop Score?

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Near the end of your pregnancy, your doctor might start referencing something called a Bishop score. This score is a system created to assess how your body is preparing for labor and delivery.

Your healthcare provider will assess the position of your baby and monitor changes in your cervix to determine your score. The score may be used to indicate if a successful vaginal delivery is likely.

Keep reading to learn more about the purpose of the bishop score, how it is calculated, and what the score means.

Doctor giving pregnant patient ultrasound

Ariel Skelley / Getty Images

Purpose

The Bishop score is a scale used by medical professionals to assess how ready your cervix is for labor. Your doctor can use the score to estimate the likelihood of a vaginal birth if you need to be induced. The higher the score, the more likely you will have a successful induction.

The score was named after its creator, Dr. Edward Bishop, who developed the criteria in 1964 to help predict labor success after being inducing.

In the days and weeks leading up to childbirth, your body starts to prepare for labor and delivery. These signs help to show if your body is prepared for a vaginal delivery.

The length, diameter, firmness, and position of your cervix change as your body prepares to deliver your baby. Usually the fetus also begins to move into position to prepare for birth. The Bishop score takes all of this into account.

The use of the Bishop score is limited in women with placenta previa (where the placenta covers the cervix) or with preterm rupture of membranes.

How Is the Bishop Score Calculated?

The Bishop scoring system assesses the cervix and fetal placement. Potential scores range from zero to a maximum of 13. The scoring system is based on five assessments completed by your doctor.

Cervical Dilation

Your healthcare provider will assess your cervix by completing a digital exam, which is a physical assessment done by inserting two fingers into the vagina to evaluate the cervix while wearing a surgical glove.

Cervical exams are usually done in the last few weeks leading up to your expected delivery date to estimate how far your cervix has opened. 

Some women won't experience any dilation of their cervix before labor, while others may be dilated one to two centimeters for weeks before labor begins.

Your doctor will score your cervical dilation on a scale of zero to three points for the Bishop score.

Effacement

As your body prepares for childbirth, your cervix will begin to thin and shorten. The average cervical length is about 3.5 centimeters. Effacement describes the shortening of the cervix and is determined by percentages of the prelabor cervix length.

  • 0% effacement is an average prelabor length.
  • 50% effacement means the cervix is half its expected length.
  • 100% effacement is a paper-thin length

The effacement is assessed during a digital exam and given a score between zero to three points.

Station

The station describes the position of your baby’s head in relation to your pelvis. Typically around two weeks before delivering, your baby will begin dropping into the birth canal.

As the baby’s head drops into position, the score moves from -3 to position 0, which is called the engaged position. When the head is at +3, the head is crowning and becomes visible in the birth canal.

Based on the fetal head position, your doctor will rate this category from zero to three points.

Cervical Position

During the digital exam, your healthcare provider will assess the position of your cervix. As your body prepares for labor, the cervix lowers to make way for the baby’s descent.

Cervical position is based on a rating scale from zero to two points.

Cervical Consistency

The consistency of the cervix is assessed during the digital exam to see how soft or firm the cervix feels.

The cervix softens as the body prepares for labor and typically is softer in people who have had previous pregnancies. It’s given a score between zero and two points.

What Does the Score Mean?

The points add up to give you a score between zero and 13. The higher the score, the more likely you are to have a vaginal delivery if induced. Here are specific Bishop score ranges and their meaning:

  • 8 or more points means you may go into labor naturally, or if you need to be induced, you will likely be able to have a vaginal delivery.
  • 6 or 7 points fall in the middle of the scale and don’t clearly indicate whether or not inducing will be successful.
  • 5 or fewer points means inducing labor is less likely to lead to a vaginal delivery, and a cesarean section (C-section) may be needed if unable to wait to induce labor. Scores in this range indicate medications, called cervical ripening agents, may be needed to help prepare your cervix for delivery if inducing is indicated.

Induction

Your healthcare provider may recommend inducing labor if you don’t go into labor within a couple of weeks of your expected due date. There are other reasons your doctor may recommend induction, but the most common is being late or post-term—41 to 42 weeks pregnant.

You and your doctor will discuss if inducing is the best option for you based on:

  • Your Bishop score
  • Number of weeks pregnant
  • The health of you and your baby

A Word From Verywell

Your Bishop score tells your healthcare provider the readiness of your cervix for labor. The score is based on changes in your cervix before labor and the head position of your baby. The primary purpose of the score is to estimate the likelihood of an induction resulting in a vaginal delivery.

The Bishop score is just one tool that your healthcare team will use to assess your cervix’s readiness for labor and the likelihood of successful vaginal delivery. Talk with your doctor if you have specific questions about your Bishop score and if inducing is a good option for you. 

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