Surreal illustration of childbirth prediction scoring system.

Will it be Vaginal or C-Section?: A Scoring System to Predict Delivery Mode

Lena Voss in Health & Wellness December 2025 • 5 min read.

"A new scoring system helps predict the likelihood of vaginal delivery, empowering women and their doctors to make informed decisions during labor."

The increasing rate of cesarean deliveries worldwide has led to concerns about maternal morbidity, mortality, and psychological trauma associated with emergency C-sections. For expectant mothers, especially those experiencing their first pregnancy, the uncertainty surrounding the mode of delivery – vaginal or cesarean – can be a significant source of anxiety.

Recognizing the need for a more predictable and controlled childbirth experience, researchers have developed scoring systems to identify factors influencing the success of vaginal birth after cesarean delivery. Now, a recent study has expanded this philosophy to non-cesarean and nulliparous women, aiming to create a comprehensive tool for predicting the mode of delivery in all term pregnancies.

This article explores the development and validation of this innovative scoring system, designed to empower women and their healthcare providers with the knowledge needed to make informed decisions during labor. By considering various obstetric and non-obstetric variables, the scoring system offers a more accurate prediction of vaginal delivery, potentially reducing the rate of unnecessary cesarean sections and improving the overall childbirth experience.

How Does the Scoring System Work?

Surreal illustration of childbirth prediction scoring system.

The study, conducted at a District Government Hospital and a University College Hospital in India, involved 835 term pregnancies in labor. Researchers used backward multiple logistic regression analysis on data from 600 women to pinpoint factors independently linked to vaginal or cesarean delivery. These factors were then assigned weighted scores based on their logistic coefficients.

The total score for each woman is calculated by summing the individual scores for each factor. To determine the predictive accuracy of the system, researchers calculated the sensitivity and specificity for vaginal/cesarean delivery at various total scores. The optimal cut-off score was then validated on both the initial group of 600 women and a new cohort of 235 laboring women.

Maternal Age: Women aged 20-25 years received a higher score, indicating a greater likelihood of vaginal delivery.
Parity: Multiparous women (those who have given birth previously) also scored higher.
Uterine Scarring: An unscarred uterus was a positive factor.
Rhesus Factor: Rhesus positivity was associated with a higher chance of vaginal delivery.
Fetal Weight: An estimated fetal weight between 2.5-3.5 kg was considered favorable.
Fetal Presentation: Cephalic presentation (head-first) was a significant factor.
Bishop Score: A Bishop score above 4, indicating cervical readiness for labor, was a positive sign.
Onset of Labor: Spontaneous onset of labor was preferred over induced labor.
Amniotic Fluid: Clear liquor (amniotic fluid) was a good indicator.
Fetal Heart Rate: Absence of fetal heart rate abnormalities was crucial.

The study revealed that a cut-off score of 21 effectively predicted vaginal delivery, with a sensitivity of 80%, specificity of 65%, positive predictive value of 70%, and negative predictive value of 76%. This means that women with a score of 21 or less were highly likely to experience vaginal delivery.

What Does This Mean for Expectant Mothers?

The development of this scoring system offers a valuable tool for predicting the mode of delivery in term pregnancies. By considering a range of factors, the system provides a more objective assessment of a woman's likelihood of achieving vaginal delivery.

It's important to note that a score above 21 does not automatically mean a cesarean section is inevitable. Instead, it serves as a guide for healthcare providers to identify women who may require closer monitoring and support during labor.

While the study's findings are promising, it's essential to acknowledge the limitations of re-evaluating the score within the same clinical setting. Further research is needed to validate the system's accuracy across diverse hospital settings and populations. Nevertheless, this scoring system represents a significant step forward in empowering women and their doctors to make informed decisions about childbirth, potentially leading to fewer unnecessary cesarean sections and a more positive birth experience.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.18203/2320-1770.ijrcog20150697, Alternate LINK

Title: Prediction Of Mode Of Delivery In Term Pregnancies: Development Of Scoring System

Subject: General Medicine

Journal: International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Publisher: Medip Academy

Authors: Swathi Kotha, Pralhad Kushtagi, Krishnapriya Radhakrishnan

Published: 2015-01-01

Everything You Need To Know

How does the scoring system actually work?

The scoring system analyzes various factors to predict the mode of delivery. These factors include Maternal Age, Parity, Uterine Scarring, Rhesus Factor, Fetal Weight, Fetal Presentation, Bishop Score, Onset of Labor, Amniotic Fluid, and Fetal Heart Rate. Each factor is assigned a weighted score based on its impact on the likelihood of vaginal delivery. The total score is then calculated, and a cut-off score is used to predict whether a woman is likely to have a vaginal delivery or require a C-section. The study found a cut-off score of 21 effectively predicted vaginal delivery.

What factors does the scoring system consider?

The factors considered by the scoring system include both obstetric and non-obstetric variables. Obstetric variables include Maternal Age, Parity, Uterine Scarring, Rhesus Factor, Fetal Weight, Fetal Presentation, Bishop Score, Onset of Labor, Amniotic Fluid, and Fetal Heart Rate, directly related to the pregnancy and delivery process. Non-obstetric variables can indirectly influence the delivery outcome. These factors, when combined, provide a comprehensive assessment of a woman's likelihood of vaginal delivery. The inclusion of a wide range of factors allows for a more accurate and informed prediction, which can lead to better decision-making during labor.

Why is this scoring system important?

The scoring system's significance lies in its potential to reduce the rate of unnecessary Cesarean sections. By providing a more objective prediction of the mode of delivery, the system empowers both women and healthcare providers to make informed decisions. This can lead to fewer emergency C-sections, which are associated with higher risks of maternal morbidity, mortality, and psychological trauma. The goal is to improve the overall childbirth experience and reduce negative outcomes.

How was the scoring system developed and tested?

The study involved 835 term pregnancies in labor. Researchers used backward multiple logistic regression analysis on data from 600 women to pinpoint factors independently linked to vaginal or cesarean delivery. These factors were assigned weighted scores based on their logistic coefficients. The optimal cut-off score was then validated on both the initial group of 600 women and a new cohort of 235 laboring women. This process ensures the scoring system's accuracy and reliability in predicting the mode of delivery for a wide range of women.

What does this mean for pregnant women?

The implications of the scoring system are significant for expectant mothers. By understanding their individual scores, women can gain a better understanding of their chances of vaginal delivery. This knowledge can reduce anxiety surrounding childbirth and allow for more active participation in the decision-making process. It also enables healthcare providers to make evidence-based recommendations, potentially leading to a more positive and controlled childbirth experience for both the mother and the baby. The system's predictive accuracy offers a valuable tool in managing labor and delivery effectively.