September 17, 2008 at 11:51 am #3089AIMSIrelandMember
AIMSI is contacted by many women asking about the terminology used for checking to see if they are favourable for labour to begin, a sweep, or for induction of labour.
One way your midwife or doctor may see if you are favourable is to perform an internal vaginal exam to check your cervix. Your carer may call this a VE verbally or on your chart.
A vaginal exam is a snapshot of your cervix at the time of the exam. One of the problems with vaginal exams is that the cervix can change at different rates – so there is no way in telling what is happening after the VE has been performed. VEs may also increase your chances of infection.
A Vaginal examination is not a sweep. Your carer needs additional consent in order to perform a sweep. A sweep is when your carer sweeps a finger between your baby’s membranes (waters) and your cervix in the hope that labour may begin. Sweeps will often cause you to have "Show" (a blood stained mucus from the plug) and sometimes you will have pains that are like contractions. About 1 in 8 women who have a sweep will go into labour within 24 hrs of having the sweep done. A sweep is more likely to work if you are favourable for labour. In other words, if you have a high Bishop’s Score and labour is likely to begin soon anyhow.
AIMSI have many women write us for information on terminology their midwives/doctors use during VEs. Please see the following guide and discuss any concerns you may have with your carers.
Your midwife or doctor will be looking for signs of change in the cervix. These signs include position of cervix, dilation, effacement.
Cervical Position & effacement: in your pregnancy, your cervix points backwards – posterior and is long and hard. Towards the end of pregnancy, and as your body begins to get ready for labour, the cervix will come forwards, and will thin and shorten in order to help your baby come into the birth canal. At this time, your cervix will be called "anterior". You may hear your midwife or doctor say that your cervix is "soft" or "hard". A ripe cervix which is ready for labour will be soft, short and anterior.
Dilation: this is a term used to see how your cervix is opening. Your cervix opens from 0-10 cm in order to give birth to your baby.
0-4 cm: Early Labor
4-8 cm: Active Labor
8-10 cm: Transition
10 cm: Fully Dilated
The Bishop’s Score is a tool used to assess if a woman is ready for labour. It is a way for your midwife or doctor to determine what would happen if you were induced at this time. Generally, woman with low Bishop’s scale results are not ready for labour and there is higher risk of her labour ended in a cesarean section. For example, a first time mother who has a Bishop’s score of 0-3 has a 45% chance of her labour ended in a cesarean section.
The Bishop’s Score generally follows this scale:
Score Dilatation Effacement Station Position consistancy
0 closed 0 – 30% -3 posterior firm
1 1-2 cm 40 -50% -2 mid-position mod/firm
2 3-4 cm 60 -70% -1,0 anterior soft
3 5+ cm 80+% +1,+2
A point is added to the score for each of the following:
Each prior vaginal delivery
A point is subtracted from the score for:
Premature or prolonged rupture of membranes
Interpretation of Bischop’s Score and outcome of births:
cesarean rates: first time mothers women with past vaginal deliveries
scores of 0 – 3: 45% 7.7%
scores of 4 – 6: 10% 3.9%
scores of 7 – 10: 1.4% .9%
Induction is generally attempted when a mother has a favorable Bishop’s score.
A score of 5 or less suggests that labour is unlikely to start without induction. A score of 9 or more indicates that labour will most likely commence spontaneously.
A low Bishop’s score often indicates that induction is unlikely to be successful. Some sources indicate that only a score of 8 or greater is reliably predictive of a successful induction.
If you have any questions or concerns regarding your favourability for induction please discuss them with your midwife or doctor. If you would like any further information on this topic please contact AIMSI at: firstname.lastname@example.org
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