Inductions & The Bishop Score
- Danielle Carter
- Aug 4, 2022
- 3 min read
One of my clients recently called me after attending her 38 week appointment with her obstetrician, confused and frustrated: as soon as she checked in for her appointment the woman at the front desk announced excitedly that they had scheduled her for her induction the following week – 4 days before her estimated due date. Unfortunately, this is a fairly common practice; 30% of births in the state of Ohio are started via induction, and inductions account for 24% of births in the U.S.[1] While there can be medical reasons present that indicate baby and mom would be safer with baby outside the womb than in, the fact remains that many labor inductions are done simply for convenience. My client's doctor thought she was doing my client a favor by “allowing” her to be done being pregnant when in reality she caused my client to second guess her own ability to achieve a non-medicalized birth.
During our talks earlier on in pregnancy almost every one of my clients highlights their desire to go into labor spontaneously. As pregnancy goes on, however, most of my clients have voiced a desire to, “just be done.” Sometimes the weight (no pun intended!) of pregnancy as it draws to a close is enough for a woman to throw all of her goals for birth out the window just to be done. Studies have shown, however, that the more time a woman spends laboring in the hospital increases the use of interventions. (This is often called “the cascade of interventions".) Going in for an induction usually means more time spent in the hospital; it's not uncommon for first time moms to have inductions that last multiple days before birth. It is also important to note that induction of labor is associated with increased rates of cesarean births in first time moms.[2] If your labor is induced it proceeds differently from spontaneous labor from the moment you check in to the hospital; contractions are more painful, progress can be slow, interventions seem to multiply, and hospital policies can hinder progress.
Common reasons your doctor may recommend induction:[3]
- Hypertension
- Diabetes
- Post-term pregnancy
- Intrauterine growth restriction
- Multiples
- Too much or too little amniotic fluid
- Premature rupture of membranes
- Maternal age
- Upcoming holiday or scheduled vacation
Some of these indicate that induction is a medical necessity; others indicate a provider or mother’s impatience. Because induction of labor is a medical event, it is vitally important that women know the risks and benefits of induction before they are asked when they would like to schedule one. The main benefit of labor induction: baby is out. If there is a medical need for baby to be born sooner than later, induction is usually the safest way to do so. There are many risks associated with induction of labor, especially before 40 weeks gestation, and I won’t get into those here. Evidence Based Birth is one of my favorite resources, so I would recommend checking out their website for articles and podcasts regarding the evidence on induction for various reasons.[4]
One of the most important and empowering discussions a woman can have with her provider when an induction is approaching is requesting to know her Bishop score. The Bishop score was developed to help predict the likelihood that an induction will result in a vaginal birth. To calculate your Bishop score your provider will consider 5 factors: cervical dilation, effacement, consistency, position, and fetal station (baby’s position in regards to mom’s pelvic bones.) The higher the score the closer someone is to spontaneous labor and the better their body will respond to an induction.
Every appointment at which your provider performs a vaginal exam you can request they calculate and tell you your Bishop score; as your pregnancy nears its end knowing your Bishop score can help you make the tough choice to schedule an induction or not. Some providers will happily discuss your Bishop score and some will brush off your request without another word. Some providers won't explicitly say they are calculating your score, but will talk about how your body is changing i.e. "Your cervix has moved forward/is soft/dilated etc." If you would like to calculate your own Bishop score you can do so here. Keep in mind the Bishop score is not a crystal ball - no one knows how your birth will go until after it happens! The more information we have before making decisions can lead us closer to or further away from achieving our birth goals.
[3] http://www.childbirthconnection.org/giving-birth/labor-induction/basics/labor-induction-basics-q-a/why-so-many.html
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