Understanding Labour Induction: Benefits, Risks, and the Role of the Bishop’s Score

Labour induction is the process of stimulating uterine contractions before spontaneous labour begins, with the goal of achieving a vaginal birth. Induction may be recommended for medical or non-medical reasons, and the decision is often based on factors such as gestational age, maternal and fetal health, and the readiness of the cervix.

Why Induction May Be Suggested

Induction of labour may be recommended for various reasons, including:

• Overdue – when a pregnancy extends beyond 41-42 weeks, increasing risks to the baby.

• Premature rupture of membranes (PROM) – when the amniotic sac breaks but labour doesn’t start on its own.

• Medical conditions – such as gestational diabetes, hypertension, preeclampsia, or other complications affecting maternal or fetal well-being.

• Fetal concerns – including restricted growth or concerns about oxygen supply.

• Elective reasons – in some cases, induction may be planned for personal or logistical reasons, though this is generally less common and requires careful consideration.

The Role of the Bishop’s Score in Induction

Before an induction is performed, your LMC will assess your cervix’s readiness using the Bishop’s Score. This scoring system evaluates:

• Cervical dilation (how open your cervix is, measured in centimeters)

• Cervical effacement (how thin your cervix has become, expressed as a percentage)

• Cervical consistency (firm, medium, or soft)

• Cervical position (posterior, mid-position, or anterior)

• Fetal station (the baby’s position relative to the pelvis)

A higher Bishop’s Score (usually 6 or above) suggests that the cervix is favourable for induction and that labour is more likely to progress successfully. A low Bishop’s Score (5 or below) may indicate that cervical ripening is needed before active labour induction methods are used.

Methods of Induction

Depending on the Bishop’s Score and individual circumstances, different methods may be used to induce labour:

Cervical Ripening

• Prostaglandin gel or pessary – This medication is applied directly to your cervix to soften and prepare it for labour. Prostaglandins help to stimulate contractions and encourage cervical dilation. The gel is typically administered in a hospital setting, with monitoring to assess both maternal and fetal responses. If labour does not start after the first application, additional doses may be given after several hours.

• Balloon catheter – A small, flexible balloon is inserted into the cervix and inflated with sterile fluid to exert gentle pressure, encouraging dilation. The balloon catheter is usually left in place for several hours and can be a suitable option when prostaglandins are not recommended or have not been effective. It is a mechanical method rather than a hormonal one, reducing the risk of excessive uterine contractions.

• Misoprostol – Misoprostol is a prostaglandin medication used to help soften and dilate the cervix, preparing it for labour. It is administered usually as an oral solution, making it a convenient option for cervical ripening. Before the first dose, the baby's heartbeat is monitored, and a vaginal examination may be performed if one hasn’t been done in the last two days. After taking the first dose, the baby’s heart rate is monitored again for about 30 minutes. The process continues with a dose of misoprostol every two hours, along with regular checks of the baby’s heart rate and contractions. This continues until labour starts or a maximum of eight doses are given in one day. If labour has not started after eight doses, the induction process is paused overnight to allow rest before resuming the next day. Since labour can begin at any time, rest is encouraged between doses, and midwives are available to provide support throughout the process.

Labour Stimulation

• Artificial rupture of membranes (ARM) – Breaking the amniotic sac manually to encourage contractions.

• Oxytocin (Syntocinon) drip – A synthetic hormone administered via IV to stimulate contractions.

• Membrane sweeping – A non-medical method where a healthcare provider sweeps a finger around the cervix to release natural prostaglandins.

Benefits of Induction

• Reduces risks associated with prolonged pregnancy, such as stillbirth or meconium aspiration.

• Helps manage maternal health conditions that could become dangerous if the pregnancy continues.

• Allows for controlled timing, particularly in high-risk situations or where healthcare access may be limited.

• Can prevent complications such as fetal distress due to declining placental function in overdue pregnancies.

• May reduce the risk of requiring an emergency caesarean if labour is induced before complications arise naturally.

Risks and Considerations

• Increased likelihood of interventions – Induction may lead to a higher chance of needing interventions like assisted delivery (forceps/vacuum) or caesarean section.

• Uterine hyperstimulation – Stronger or too-frequent contractions can distress the baby and may require medical intervention.

• Longer labour – If the cervix is not ready, the induction process can take longer than spontaneous labour.

• Failed induction – In some cases, induction may not lead to labour, requiring a caesarean birth.

• Increased pain – Induced contractions can be stronger and more painful than natural ones, often requiring pain relief options such as an epidural.

• Neonatal risks – There may be an increased risk of baby experiencing breathing difficulties or needing neonatal intensive care in some cases.

Making an Informed Decision

Deciding whether to proceed with an induction is a personal choice, guided by medical advice. You should feel empowered to ask questions, seek clarification, and fully understand the process, including alternative options and possible outcomes.

Understanding the reasons for induction, the potential benefits, and the associated risks allows you to make a choice that aligns with your birth preferences and medical needs. Discussing the Bishop’s Score with your LMC and healthcare team and considering the likelihood of a successful induction may help guide the decision.

It’s important to ask about alternative approaches, such as waiting for labour to start naturally, and to be aware of pain management options during induction.

Being actively involved in the decision-making process ensures that you feel confident and informed, contributing to a more positive birth experience, regardless of the outcome.