Using the Bishop Score & Natural Induction: What You Need to Know
- Ashley Strengholt
- Aug 21
- 4 min read
Updated: Sep 19
You’re 39 weeks pregnant, sitting in your OBGYN’s office, and they mention the possibility of induction. You might wonder: Is my body even ready for labor? Great question, mama! Let’s dive into how your provider can help you determine whether your body is ready. The Bishop Score is a simple, decades-old tool that helps answer this question.
By understanding your Bishop Score you can make informed decisions about whether to wait, try natural induction methods, or consider medical induction. I’ll share with you the history of the Bishop Score, how it’s calculated, and the safest, most effective natural induction options for your unique situation.
What Is the Bishop Score?
The Bishop Score is a clinical scoring system used the assess the readiness of the cervix for labor. It was developed in 1964 by Dr. Edward Bishop and was originally used to predict the success of elective inductions in first-time mothers (Bishop, 1964)
Since then, it has become a standard tool in obstetrics around the world. Your provider assigns a score after a cervical exam which helps them determine whether induction is likely to lead to a vaginal birth or whether cervical ripening is needed first.
How the Bishop Score Is Calculated
The Bishop Score evaluates five main factors:
1. Cervical dilation – How open the cervix is (0-10 cm).
2. Cervical effacement – How thin or “short” the cervix has become.
3. Cervical consistency – Firm, medium, or soft.
4. Cervical position – Posterior (toward the back), mid, or anterior (toward the front).
5. Fetal station – How far the baby’s head has descended into the pelvis.
Each factor is given a score, and the total can range from 1 to 13. Some versions adjust the score for previous births or certain complications.
Interpreting the score:
· 0 – 4: Unfavorable cervix; induction less likely to succeed without ripening.
· 5 – 8: Moderately favorable; could respond well to induction.
· 9+: Highly favorable; spontaneous labor likely soon.
(ACOG Practice Bulletin No. 107, 2009)
Why the Bishop Score Matters
For healthcare providers, the Bishop score is a guide for deciding between waiting, ripening the cervix, or starting induction medications.
For expectant parents, knowing your score is empowering as it helps you to:
· Understand your likelihood of a smooth induction.
· Decide if you would like to try natural ripening methods first.
· Avoid unnecessary interventions when possible.
A low score often means longer labor, higher risk of failed induction, and greater chance of cesarian birth. (Cochrane Pregnancy & Childbirth Group, 2015).
Natural Inductions Methods Based on Your Score
If Your Score is Low (0 – 4): Focus on Cervical Ripening
Goal: Soften and prepare the cervix.
Evidence-based methods:
· Dates: Eating 6 dates daily in the last month of pregnancy may help cervical ripening and shorten early labor (Kordi et al., 2014). If you have Gestational Diabetes, make sure to talk to your nutritionist about how to balance the carbohydrates from the dates with protein so you don’t spike your blood sugar.
· Evening Primrose Oil (EPO): Contains gamma-linolenic acid, which may influence prostaglandin production. May be taken orally or vaginally; results are mixed so consult your provider.
· Acupuncture/Acupressure: May support cervical ripening and promote contractions (Smith et al., 2017).
· Sexual Intercourse: What gets the baby in, gets the baby out! Semen contains prostaglandins; orgasm may trigger uterine activity. Do not utilize this method if your water has broken.
If Your Score is Moderate (5 – 8): Combine Ripening with Gentle Contraction Stimulation
Goal: Support both cervical change and early uterine activity.
Try:
· Walking or upright positions: Gravity encourages baby’s head to apply pressure to the cervix.
· Gentle nipple stimulation: Can increase oxytocin release, sometimes starting contractions.
· Spinning Babies exercises: Help optimize fetal position.
· Relaxation and warmth: Warm baths or guided relaxation can promote oxytocin flow.
If Your Score is High (9+): Stimulate Contractions
Goal: Move from readiness into active labor.
Possible options:
· More vigorous nipple stimulation: Frequent, short sessions.
· Membrane sweep: Performed by a provider; releases natural prostaglandins.
· Curb walking or stair climbing: Adds pelvic motion and gravity to encourage baby’s descent.
· Prostaglandin-rich foods: Pineapple or spicy foods – evidence is anecdotal evidence, but many try them.
Important Safety Notes
· Always consult your healthcare provider before starting any induction method.
· Avoid castor oil unless advised and monitored – it can cause strong, distressing contractions and dehydration.
· If you notice decreased fetal movement, vaginal bleeding, leaking amniotic fluid, or severe pain, seek medical care immediately.
Final Thoughts
The Bishop Score isn’t just a number – it’s a tool for understanding your body’s readiness for labor. When you know your score, you can better weigh the pros and cons of induction. Having this knowledge before having this conversation with your provider will help you be able to make an informed decision and approach your birth with confidence.
By matching your induction approach to your Bishop Score, you may improve your chance of a smoother, safer labor – whether it starts on its own or with a little nudge.
References:
Bishop, E.H. (1964). Pelvic scoring for elective induction. Obstetrics & Gynecology, 24(2), 266–268.
American College of Obstetricians and Gynecologists (ACOG). (2009). Induction of labor. Practice Bulletin No. 107.
Cochrane Pregnancy and Childbirth Group. (2015). Bishop score for predicting induction success.
Kordi, M., et al. (2014). The effect of date fruit consumption on labor and delivery outcomes. Journal of Midwifery and Reproductive Health, 2(3), 150–156.
Smith, C.A., et al. (2017). Complementary and alternative therapies for labour induction. Cochrane Database of Systematic Reviews, (11).
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