Late Pregnancy · Induction
Bishop Score — Cervix Readiness for Labour
The 0-13 score your midwife uses to assess whether your cervix is ready for labour. Higher = closer to spontaneous labour and better induction success. Plus what Propess, Foley balloon, and oxytocin do at different scores. NICE NG207.
Last reviewed 2 June 2026
Modified Bishop Score
Pre-induction cervical readiness
Score all five components to see the total.
Bishop score is the standard pre-induction assessment in NICE CG70 and ACOG PB 107. It is a clinician’s assessment tool — patients shouldn’t score themselves, but understanding the components helps inform the induction conversation.
What does this mean?
The Bishop score tells you how “ripe” (ready) the cervix is for labour. A score ≥ 8 means induction with oxytocin alone has a similar success rate to spontaneous labour; 6–7 is borderline; ≤ 5 usually means cervical ripening is needed first (prostaglandin gel/tablet, misoprostol, or a Foley balloon over 6–12 h) so the oxytocin drip has something to work on. The five components are physical findings only a clinician can assess on vaginal exam — dilation, effacement (thinning), station (how low the baby sits), consistency, and cervical position. Knowing your score helps frame the induction conversation: a low score means “expect 12– 24 h ripening before the active labour drip”, a high one means “we’ll start with the drip and you may meet your baby within the day”.
What is the Bishop score?
A 5-point cervix readiness score used to predict how likely induction is to work. Introduced by Edward Bishop in 1964.
Scores:
- Dilation (how open).
- Effacement (how thin).
- Station (how low the baby’s head is).
- Consistency (how soft).
- Position (posterior, middle, anterior).
Total: 0-13.
What does my score mean?
- 0-5 unfavourable: ~50% induction success; needs ripening first.
- 6-7 intermediate: some ripen, some try oxytocin straight.
- 8-13 favourable: ~95% success; often just oxytocin + amniotomy.
Bishop scoring grid
5 items, each 0-3 points:
- Dilation: closed (0), 1-2 cm (1), 3-4 cm (2), ≥5 cm (3).
- Effacement: 0-30% (0), 40-50% (1), 60-70% (2), ≥80% (3).
- Station: -3 (0), -2 (1), -1/0 (2), +1/+2 (3).
- Consistency: firm (0), medium (1), soft (2).
- Position: posterior (0), middle (1), anterior (2).
If your Bishop is low
Ripening options:
- Propess (prostaglandin E2 pessary) — 12-24h; UK first-line.
- Prostin gel — 6h, repeated.
- Foley balloon / Cook balloon — mechanical; 12h; safer for VBAC.
- Misoprostol (Cytotec) — some units; NOT for VBAC.
After ripening: oxytocin + amniotomy to establish labour. Can take 24-48h total.
Does Bishop predict C-section risk?
- Low Bishop: ~30-40% C-section after induction.
- Favourable Bishop: ~10-15% C-section.
- Nulliparous (first baby) + low Bishop: highest C-section risk (~40%+).
- Multiparous + same Bishop: much better outcomes.
Bishop changes during induction
Each ripening agent improves Bishop. Checks at admission, after each agent, before next step. Progress: 4 → 6 → 8 → established labour. Sometimes no progress (failed induction ~5-15%).
Posterior cervix
Cervix points BACKWARD toward spine; baby’s head not yet engaged behind it.
As labour approaches, cervix moves anterior (forward, under baby’s head). Posterior usually = less favourable Bishop.
Parity matters
- First baby: typically less favourable Bishop; longer ripening; higher C-section risk.
- Second+ baby: cervix often more pre-ripened; quicker response; lower C-section risk.
Different scenarios — Bishop scoring
Scenario 1: First baby, 40 weeks, Bishop 3
Unfavourable. Propess overnight; recheck morning; if Bishop >6, amniotomy + oxytocin. C-section risk ~30-40%.
Scenario 2: Second baby, 39 weeks, Bishop 7
Intermediate but multiparous. May try amniotomy + oxytocin directly. Often quick response.
Scenario 3: Post-dates 41+5, Bishop 9
Favourable. Sweep may bring labour spontaneously; if induction: amniotomy + oxytocin alone usually works.
Scenario 4: VBAC, 40 weeks, Bishop 4
Unfavourable + VBAC = challenging. Foley balloon preferred over prostaglandins (lower rupture risk). Careful induction. Continuous CTG. Discuss risk-benefit.
Scenario 5: Low Bishop + medical indication for delivery
Pre-eclampsia / GR / etc means induction MUST proceed even with low Bishop. Discuss elective C-section as alternative; some prefer if Bishop very low.
Care guidance — Bishop scoring
- Done by midwife / doctor via internal exam.
- Multiple checks through induction.
- Low Bishop = expect longer induction.
- Favourable Bishop = expect quicker response.
- Parity matters as much as score.
- Discuss alternatives if low Bishop + medical indication.
- Patience — ripening can take 24-48h.
- Cervical length ultrasound can add information.
Sources
- Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol 1964.
- NICE NG207. Inducing labour.
- RCOG Green-top Guideline 107. Induction of labour.
- WHO. Recommendations for induction of labour.
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Frequently asked questions
What is the Bishop score?
5-point CERVIX READINESS score used to predict how likely induction is to work. Introduced by Edward Bishop in 1964. Scores DILATION (how open), EFFACEMENT (how thin), STATION (how low the baby's head is), CONSISTENCY (how soft), and POSITION (forward or back). TOTAL 0-13. PREDICTS induction success: FAVOURABLE cervix (Bishop ≥ 8) usually responds well to oxytocin alone; UNFAVOURABLE (≤ 5) typically needs RIPENING agent (prostaglandins or balloon) first. Used by midwives + doctors during cervix check before / during induction.
What does my Bishop score mean for induction?
BISHOP 0-5 (UNFAVOURABLE / UNRIPE): induction success ~50%; needs CERVICAL RIPENING agent first (Propess pessary, prostaglandin gel, Foley balloon). May take 12-24+ hours to ripen. Often slower start. BISHOP 6-7 (INTERMEDIATE): some clinicians ripen first, others try oxytocin straight. BISHOP 8-13 (FAVOURABLE / RIPE): excellent success rate (~95%); often just oxytocin + amniotomy (artificial waters break). FAVOURABLE cervix = labour usually within 12-24 hours. Bishop predicts likely speed + need for cervix prep.
What's a favourable cervix?
BISHOP ≥6 (often ≥8) means cervix is RIPE — soft, opening, thinning, and baby's head is descending. Body biology is ready for labour. Sometimes happens naturally at 38-41 weeks; sometimes needs help. FAVOURABLE: success of induction high; sweeps work better; labour usually shorter once started. UNFAVOURABLE: opposite — cervix posterior, firm, closed, baby's head higher up. NEEDS ripening medication before active labour can begin.
How is Bishop scored exactly?
5 ITEMS, each 0-3 points (except station: 0-3): (1) DILATION — closed (0), 1-2 cm (1), 3-4 cm (2), ≥5 cm (3). (2) EFFACEMENT — 0-30% (0), 40-50% (1), 60-70% (2), ≥80% (3). (3) STATION (where baby's head is in pelvis, relative to ischial spines) — -3 (0), -2 (1), -1/0 (2), +1/+2 (3). (4) CONSISTENCY — firm (0), medium (1), soft (2). (5) POSITION — posterior (0), middle (1), anterior (2). TOTAL: 0-13 (some versions 0-12). HIGHER = more favourable / closer to labour.
Why does Bishop score matter?
(1) PREDICTS how soon labour starts; (2) GUIDES induction approach — sweep vs prostaglandin vs balloon vs oxytocin first; (3) PREDICTS C-SECTION risk — low Bishop = higher C-section risk; (4) HELPS shared decisions about induction timing and method; (5) STANDARDISES communication between care providers — 'Bishop 4' is universally understood. CAN BE done multiple times during induction to track progress.
What happens if my Bishop score is low?
Need CERVICAL RIPENING before active labour can start. OPTIONS: (1) PROPESS (prostaglandin E2 pessary) — inserted vaginally; works 12-24 hours; most common UK first-line. (2) PROSTIN GEL — prostaglandin gel; works 6 hours; repeated. (3) FOLEY BALLOON / COOK BALLOON — mechanical; inserted in cervix; works 12 hours; alternative for VBAC or contraindication to prostaglandins. (4) MISOPROSTOL (Cytotec) — used in some units; not for VBAC. AFTER RIPENING: oxytocin drip + amniotomy to establish active labour. CAN TAKE 24-48 hours from start.
Can Bishop score change during induction?
YES. Each agent / sweep is intended to improve Bishop. CHECKS done: at admission, after each agent (e.g. 6 hours post-Propess), before next step. PROGRESS: Bishop 4 → 6 → 8 → established labour. SOMETIMES NO PROGRESS — failed induction (rare, 5-15%); decision then re-evaluated (more time, change agent, C-section). PROGRESS often slow at first then accelerates. PATIENCE important.
Should I avoid induction with low Bishop?
DEPENDS on indication. POST-DATES alone with low Bishop and otherwise low risk: WAIT until 42 weeks possible; expectant management with twice-weekly CTG / scans (NICE NG207 supports). PRE-ECLAMPSIA / GROWTH RESTRICTION / etc: induction PROCEED even with low Bishop — risks of delay outweigh longer induction. DISCUSS with team — sometimes elective C-section is alternative for low Bishop + medical indication, depending on situation.
Does Bishop predict C-section risk?
LOW BISHOP: higher C-section rate after induction (~30-40%). FAVOURABLE BISHOP: lower C-section rate (~10-15%). NULLIPAROUS (first baby) + low Bishop = highest C-section rate (~40%+). MULTIPAROUS (had baby before) + low Bishop = much better (~20%). REASON: low Bishop labours longer; fetal distress more likely; failure to progress more likely. CHOOSING induction at low Bishop: accept this higher risk; some prefer elective C-section.
What if induction doesn't work?
FAILED INDUCTION ~5-15%. Reasons: cervix doesn't open; baby in poor position; fetal distress; uterine inertia; placental issues. NEXT STEPS: depending on situation — (1) PROLONGED RIPENING (more prostaglandin / balloon time); (2) CHANGE METHOD; (3) AMNIOTOMY + OXYTOCIN escalation; (4) ELECTIVE C-section if failed and continuing risky. NOT YOUR FAULT — cervix biology variable. Some women's bodies respond beautifully; others don't.
Does my Bishop score predict natural labour timing?
PARTIALLY. HIGH BISHOP at 38-40 weeks suggests body close to labour — could happen any time. LOW BISHOP at 40+ weeks: probably needs help. BUT: BIOLOGICAL VARIATION huge — some women go from closed cervix to fully dilated in days; others stay at 3 cm dilated for weeks. NOT A RELIABLE crystal ball — just a guide. SOME first-time mums dilate to 3-4 cm before labour starts; some are closed until contractions establish.
What's a posterior cervix and why does it matter?
CERVIX position relative to baby's head. POSTERIOR (Bishop point 0): cervix points BACKWARD toward your spine; baby's head not yet engaged behind it. ANTERIOR (Bishop point 2): cervix in middle of pelvis, behind / under baby's head. AS LABOUR APPROACHES: cervix moves from posterior to anterior (descends and rotates). POSTERIOR usually = less favourable; lower Bishop. NORMAL part of pre-labour transition. SWEEP / RIPENING agents help cervix descend.
Can I have a sweep with low Bishop?
SOMETIMES NOT — if cervix too closed for finger to access, sweep not possible. MIDWIFE will tell you 'cervix not favourable for sweep'. RETRY in few days if cervix changes. OR alternative methods (Propess, balloon). LOW Bishop sweep success much lower than favourable. NICE NG207 still supports trying sweep at low Bishop in many cases.
Does parity (previous births) affect Bishop interpretation?
YES. FIRST BABY (nulliparous): cervix typically less favourable; longer ripening time; longer induction; higher C-section risk. SECOND+ BABY (multiparous): cervix often more 'pre-ripened' at term; quicker response to induction; lower C-section risk; shorter labour. SAME Bishop score predicts BETTER outcomes in multiparous women. CAN START straight at amniotomy/oxytocin with lower Bishop in multiparous than nulliparous.
What's the alternative to Bishop scoring?
TRANSVAGINAL CERVICAL ULTRASOUND: measures cervical length objectively. RESEARCH shows cervical length + Bishop together more accurate than either alone for predicting induction success. NOT ROUTINE in most UK units. SOME ALTERNATIVE SCORES: simplified Bishop, modified Bishop, Calder, Burnett — variants. CLINICAL JUDGMENT remains important — score is guide, not absolute.
How does this relate to other calculators on BumpBites?
Companion: /calculators/membrane-sweep for offered before induction; /calculators/vbac-success if VBAC planning; /calculators/contraction-timer for labour onset; /calculators/birth-plan-builder; /calculators/labor-pain-coping; /calculators/hospital-bag-checklist; /calculators/gbs-prophylaxis.