What Does A Bishop Score Mean?


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While most labors begin spontaneously, sometimes it’s medically necessary for a baby to be born before the mom’s body is ready. Induction is often indicated if a pregnancy reaches the 41- or 42-week mark or if continuing the pregnancy would endanger the mother's or her child's health. One way to tell how successful induction will likely be is with a Bishop score.

What Is A Bishop Score?

The Bishop score is a pre-labor scoring system that helps to predict how close a woman is to going into labor on her own and how successful induction is likely to be. The total score is calculated by assessing five components:

  • cervical dilation - the width of the cervical opening, where 10 cm is fully dilated and ready for delivery
  • cervical effacement - a measure of how thin the cervix is, where 100% is fully effaced and ready for delivery
  • cervical consistency - an assessment of the relative firmness of the cervix, where “firm” indicates dilation will be more difficult, and “soft” allows for easier dilation
  • cervical position - the position of the cervix in relation to the opening of the vagina, where an anterior position (close to the opening) indicates that labor is close
  • fetal position - the position of the unborn child’s head in relation to a specific point in the pelvis, where a negative number means that the baby’s head has not descended past the pelvic marker (ischial spines), and a positive number indicates that the head has descended and is near the proper position for delivery

The highest possible Bishop score is 13, which indicates that delivery of the baby is imminent and induction is usually unnecessary. The lowest possible score is 0, which indicates that spontaneous labor is not likely to occur soon and labor will be difficult to induce. A low Bishop score also increases the likelihood of a C-section.

How Is A Bishop Score Helpful?

When a baby needs to be delivered before the mom’s body is ready, the options are to induce labor or to perform a C-section. Inductions tend to come with fewer complications and quicker recovery time, so healthcare providers must have a reliable way to determine the best candidate for induction. This is where the Bishop score comes into play. Any score over 8 or 9 typically means that an induction, if medically indicated, will likely result in a successful vaginal birth. A score of 6 or less typically means that induction is unlikely to be successful, and further medical intervention may be required if delivery is medically necessary.

Are There Problems With Using A Bishop Score?

While the Bishop scoring system is a very helpful tool, expectant mothers and their doctors should keep in mind that it’s not without its limits. A Bishop score can change rapidly, especially for women who have had children in the past. Another limitation is that obstetric providers don’t always use the same scale. Some prefer to use a “modified” Bishop score that only measures cervical dilation, effacement, and the baby’s position in the birth canal.

It’s also important to note that the Bishop scale isn’t always an accurate predictor of a successful induction and can’t be relied upon exclusively. Certain medical conditions and the mother and baby's overall health may limit the Bishop score's usefulness. For example, placenta previa (where the placenta covers the cervix) makes a safe vaginal birth impossible, no matter what the Bishop score shows. And suppose a woman’s water breaks prematurely. In that case, a pelvic exam puts the mother and baby at risk of infection, making it potentially dangerous to examine the cervix well enough to determine the Bishop score.

What Can Happen When Obstetric Providers Don’t Use The Bishop Score?

While a Bishop score should never be the sole decision-making factor when it comes to induction, it should still be taken into account unless other health conditions prevent a safe vaginal birth. If a Bishop score is less than 6 and a healthcare provider still recommends an induction, the mother is likely to have a long, difficult labor that may result in a C-section. This can mean unnecessary pain and suffering for the mother and can be stressful and potentially dangerous for the unborn child.

If you or a loved one had a low Bishop score, had a C-section, and your child has been diagnosed with either hypoxic ischemic encephalopathy (HIE) or cerebral palsy (CP), give us a call. 

Why Choose Ross Feller Casey?

Suppose a doctor or other healthcare provider either ignored your Bishop score and attempted an induction when it was unlikely to succeed or followed the Bishop score guidelines even when another medical condition made a Bishop score irrelevant. In that case, you may be entitled to compensation for any injuries resulting from their negligence.

For example, maybe your baby suffered complications due to a difficult induction, or perhaps you or your loved one suffered complications due to an emergency C-section after a failed induction. If negligence related to the Bishop score caused either hypoxic ischemic encephalopathy (HIE) or cerebral palsy (CP), the legal team at Ross Feller Casey is ready to help.

Our lawyers and a team of leading, on-staff doctors will work together to determine whether your healthcare provider caused a birth injury by paying too much or not enough attention to your Bishop score. There’s no fee unless you win, and consultations are always free. So, contact us today.

About the Author

Scott Vezina concentrates his practice on representing individuals who have suffered catastrophic brain or spinal cord injuries caused by medical negligence and product defects.

Scott Vezina

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