From birth, your baby will be evaluated to ensure that he or she is doing okay. In fact, your baby will be tested one minute after birth and then five minutes later and assigned an Apgar score. If your newborn scores low on the first Apgar tests, he or she may be tested again at various time intervals to check for deterioration and/or improvement.
History of Apgar
Apgar scoring was initially introduced by Dr. Virginia Apgar in 1952. The test carries her name, but the letters of her name are now linked to the tests for an acronym with the letters matching as follows: a = appearance, p = pulse, g = grimace, a = activity, and r = respiration.
Dr. Apgar felt that newborns were not adequately evaluated and attended to following birth. Doctors focused on the mother, and the baby was whisked away by attendants. Apgar felt that babies should be systematically evaluated immediately so that if medical attention was needed, it would be quick.
Checking the Newborn
Your attending physician or midwife will check your newborn’s heart rate, color, breathing, muscle tone, and reflexes in assigning an Apgar. Each variable carries up to 2 points for a total of 10 possible. For example, your baby would be assigned a full 2 points for heart rate with a normal 100 beats per minute. The score would be 1 for a heart rate below 100 beats per minute and 0 if no heartbeat (or pulse) is detected.
Understanding Each Apgar Assessment
A (appearance) – The doctor basically looks at the skin color of your baby. A newborn should be a healthy pinkish color at or shortly after birth. A blue or bluish tint means a lower score.
P (pulse) – This measure is the heart rate and checked with a stethoscope. Obviously a baby should be breathing and regularly to be in good shape.
G (grimace) – When a baby is stimulated lightly (a mild pinch for instance), he or she should react. A facial grimace is the typical response, and most newborns will also cough, sneeze, or cry when stimulated.
A (activity) – A healthy baby will move. If an infant’s muscles are floppy or loose, then the doctor will continue to monitor.
R (respiration) – This is an evaluation of your babies breathing. If your newborn is crying, he or she is breathing well.
Scoring – The Numbers
The overall scale runs from 0 to 10 with 10 being the best possible score. Any score below 3 suggests concerns (though problems may be temporary). Immediate medical attention may be needed, and doctors will closely watch infants in the low score ranges. Scores from 4 to 6 are regarded as borderline, and your baby will be watched closely. If your newborn scores 7 or above, he or she is considered in the normal range.
Very few babies score a perfect 10 on the Apgar. One common deduction is for a bluish tint in the hands or feet immediately following birth. The typical healthy newborn, in an uneventful delivery (although all seem quite dramatic), scores 8 or 9.
Low Scores on Apgar
If your baby scores in the low range, he or she needs immediate medical attention. That’s why the Apgar test was developed and implemented across the nation. It’s simply a test to ensure that your newborn gets the medical help he or she needs and quickly.
Infants delivered by caesarian, those who had a long and/or difficult delivery and premature infants frequently have low Apgar assignments. This simply means that most of these babies need some extra care and attention.
A low Apgar score does not indicate that your baby will have future medical concerns or that he or she will be less active or less intelligent. Apgar is simply a way for the medical community to respond appropriately to your infant’s needs immediately following birth. Most low scoring babies go on and do just fine. If there are serious problems, it’s good to address those as quickly as possible, and Apgar scoring helps in determining which little ones do need additional care.