Using the Bishop Score & Natural Induction: What Every Expectant Parent Should Know
As your due date approaches, conversations about labor; when it will start, whether induction is needed, and how ready your body is, often become more frequent. One tool commonly used in these discussions is the Bishop Score. Understanding this score can empower you to make informed decisions and, when appropriate, choose natural methods that support your body’s readiness for labor rather than forcing it before it’s prepared.
What Is the Bishop Score?
The Bishop Score is a clinical tool used to assess cervical readiness for labor, particularly prior to induction. It was developed in 1964 by Dr. Edward Bishop to help predict whether an induction of labor was likely to result in a vaginal birth.
The score evaluates five factors:
- Cervical dilation
- Cervical effacement
- Cervical consistency
- Cervical position
- Fetal station
Each factor is assigned a numerical value, creating a total score that ranges from 0 to 13.
Research consistently shows that higher Bishop Scores are associated with higher induction success rates and lower cesarean risk, while low scores are linked to longer labors and increased interventions when induction is attempted too early. ¹²
Interpreting the Bishop Score
- 0–5: Cervix is unfavorable
- 6–7: Moderately favorable
- 8 or higher: Favorable; induction or spontaneous labor is more likely to progress efficiently
A low Bishop Score does not mean labor is failing; it often means the body needs more time or gentle cervical preparation.
Why Cervical Readiness Matters
The American College of Obstetricians and Gynecologists (ACOG) emphasizes that cervical favorability is a major predictor of induction success. ³ Inducing labor when the cervix is unripe increases the likelihood of:
- Prolonged labor
- Use of synthetic oxytocin (Pitocin)
- Epidural placement
- Cesarean birth for failed induction
Supporting cervical ripening before induction; whether medically or naturally can reduce these risks. ⁴
Natural Induction Based on Bishop Score
Natural methods are most effective when matched to the body’s level of readiness rather than used indiscriminately.
Bishop Score 0–5: Focus on Cervical Ripening
At this stage, methods that support softening and positioning of the cervix are most appropriate.
Evidence-supported options include:
- Sexual intercourse
Semen contains prostaglandins that may assist cervical ripening, and orgasm promotes endogenous oxytocin release. ⁵ - Nipple stimulation
Shown in multiple studies to increase oxytocin levels and promote cervical change when used cautiously in low-risk pregnancies. ⁶ - Evening primrose oil (EPO)
While evidence is mixed, some studies suggest vaginal use may improve Bishop Score prior to induction. ⁷ Providers should be consulted before use. - Relaxation and stress reduction
Elevated catecholamines inhibit oxytocin release. Emotional safety, rest, and reduced fear are essential for physiological labor. ⁸ - Optimal fetal positioning
Upright posture, pelvic mobility, and forward-leaning positions encourage engagement, which naturally supports cervical change. ⁹
Bishop Score 6–7: Encourage Coordination
When the cervix is showing readiness, methods that support descent and uterine coordination may be effective.
- Walking and upright movement
Gravity assists fetal descent and cervical pressure, promoting prostaglandin release. ¹⁰ - Acupressure and acupuncture
A Cochrane review found acupuncture may increase the likelihood of spontaneous labor and reduce medical induction rates. ¹¹ - Continued nipple stimulation
Often more effective once the cervix has begun softening and thinning. ⁶
Bishop Score 8+: Supporting the Onset of Labor
At this stage, labor may be imminent. Gentle stimulation may help contractions organize.
- Breast pumping or nipple stimulation
Shown to reduce post-dates pregnancies and increase spontaneous labor in low-risk individuals. ¹² - Stair walking, curb walking, and positional work
Encourages fetal descent and rotation, which can initiate labor patterns. ⁹
An Important Perspective
The Bishop Score is a tool—not a mandate. Labor onset is influenced by hormonal balance, emotional safety, fetal readiness, and maternal well-being—factors no score can fully measure.
Evidence consistently supports that waiting for physiologic readiness, when medically appropriate, results in better outcomes for both parent and baby. ³⁴
Final Thoughts
Understanding your Bishop Score allows you to move from fear-based decisions to informed, collaborative choices. Rather than asking how to make labor start, the better question is often:
“How can we support my body in becoming ready?”
When the cervix, uterus, baby, and hormones are aligned, labor tends to unfold more smoothly—and with fewer interventions.
References
Yildirim G et al. Nipple stimulation in post-term pregnancy. J Matern Fetal Neonatal Med.
Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964.
Laughon SK et al. Predictors of success of labor induction. Obstet Gynecol. 2012.
ACOG Practice Bulletin No. 107: Induction of Labor.
Grobman WA et al. Outcomes associated with induction of labor after cervical ripening. AJOG.
Tan PC et al. Coitus and cervical ripening. BJOG.
Kavanagh J et al. Breast stimulation for cervical ripening and induction. Cochrane Database.
Dove D, Johnson P. Oral evening primrose oil and Bishop Score. J Nurse Midwifery.
Buckley SJ. Hormonal physiology of childbearing. Childbirth Connection.
Simkin P, Ancheta R. The Labor Progress Handbook.
Lawrence A et al. Maternal positions and mobility during labor. Cochrane Review.
Smith CA et al. Acupuncture for induction of labor. Cochrane Review.