At some point during a pregnancy, the topic of labor induction might emerge. Inducing labor means that contractions are being started before a patient begins labor naturally or without any external influence. Elective inductions of labor has doubled in the past 20 years according to medical literature. Early term inductions of labor that begin between 37 and 38 weeks have quadrupled from 2 to 8% within the U.S. Inductions are usually done when the risk of maintaining the pregnancy poses a threat to the mother or fetus. However, more and more patients have requested to have an induction of labor based on personal preference. Early elective inductions have recently been criticized because of an association with an increase in fetal and newborn complications as well as an increase in the C. Section rate.
The Bishop Score was developed in the 1960’s by Dr. Edward Bishop as a means of evaluating the cervix to determine if the patient would successfully have a vaginal delivery. Based on Bishop’s research, he determined that women who were pregnant for the first time and women who had an “unfavorable” cervix were at risk for not having a successful vaginal delivery. He used a score to determine the status of the cervix that included dilatation (opening of the cervix); station (is it towards the front, middle or back in relation to the vagina); effacement (is it thin); consistency (soft or hard) and fetal station (how high or low is the baby in relation to the vagina). A score of greater than 8 is associated with a successful vaginal delivery. An example of the Bishop Score is available as an iPad®application. An unfavorable score is less than 6 which is associated with a high probability of an unsuccessful induction of labor as well as fetal and maternal complications and an increased risk of a C. Section. What should you do if you need an induction of labor but have a low Bishop score? Discuss cervical ripening options with your healthcare practitioner. Cervical ripening is a method of making the cervix soft so that it will respond to the medicine that is used for labor induction. Some medications work better than others and a discussion of possible side effects should also occur.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.