Everything You’ve Always Wanted to Know About Agpar Scores But Were Too Afraid to Ask
History
In 1952, an anesthesiologist named Virginia Apgar proposed a formula be devised that could be used by all medical professionals to assess the condition of a newborn infant. Up until that time anyone—doctor, midwife, nurse or anesthesiologist—could (and would) simply look at a baby during the time they remained in the delivery room and the conversation could go something like this:
Doctor: “He’s a bit floppy, let’s suction him again.”
Nurse: “Maybe a bit of oxygen will pink him up a little, do you think blow-by would be enough?”
Midwife: “I’m going to rub him a bit with a towel here on Mom’s tummy and get some better muscle tone.”
Mother: “Isn’t he too blue?”
Yes, he is blue and it is has been five minutes and someone could have/should have tried all of the above, but you get the idea that assessment of a newborn was haphazard at best, and could have been managed better. We have attempted to make alternative arrangements over the years in deciding who the decision-makers in the delivery or birthing room (or home) are going to be, but our wise friend Dr. Virginia Apgar gave us a tool to use that would become a universal way of guiding our protocols, which just means we now know what we should be seeing in a newborn, when we should be seeing it, and what to do about it if we don’t. It was decidedly instrumental in taking an ambiguous concept and turning it into a workable framework in order to obtain an accurate reflection of the observations at present. Actually very simple, it works, and Apgar scoring has changed very little since its inception. I am including a short summary of the Apgar Score to give a little background for how this played into my own research and work in bonding.
What is the Apgar score?
Ninety percent of term infants make a successful and uneventful transition from living within the womb to the outside world. About ten percent will need some medical intervention and less than one percent will require extensive resuscitation. A reproducible and rapidly determined rating system is necessary for evaluation of the newborn infant. The Apgar score is a practical method for assessing a newborn.
How is the Apgar score done?
The Apgar score is a number calculated by scoring the heart rate, respiratory effort, muscle tone, skin color, and reflex irritability. Each of these objective signs can receive zero, one, or two points.
What does a high or low Apgar score mean?
A perfect Apgar score of ten means an infant is in the best possible condition. An infant with an Apgar score of zero to three needs immediate resuscitation. It is important to note that diligent care of the newborn is an immediate response to the current status of the infant. It is inappropriate to wait until Apgar scores are obtained to begin or continue to address the needs of the newborn.
Why was the Apgar score developed?
The score is named for the preeminent American anesthesiologist Dr. Virginia Apgar (1909-1974), who invented the scoring method in 1952. Having assisted at thousands of deliveries, Dr. Apgar wished to focus attention on the baby. Babies were traditionally dispatched directly to the nursery, often without much formal scrutiny after delivery. Apgar wanted the baby to be assessed in an organized and meaningful manner by the delivery room personnel. Dr. Apgar was the first woman to be appointed a full professor at Columbia University’s College of Physicians and Surgeons.