In the delivery room as your baby’s birth becomes more imminent, a nurse will come in who’s sole responsibility is your baby. Immediately after your baby is born, this nurse will assess your baby in five areas. Unlike other newborn procedures your baby may undergo, this is non-invasive. I’m talking about the APGAR Score.
What is the APGAR Score?
The APGAR Score was developed in 1952 by Dr. Virginia Apgar, an anesthesiologist. It was originally used to quantify the effects of anesthesia on the baby. This non-invasive test is performed at one and five minutes of age and is a measure of your baby’s physical condition. Your baby will be assessed for Appearance, Pulse, Grimace, Activity, and Respiration at one minute and five minutes of being born. In each category your baby will be scored from 0-2, with the highest score being 10. This assessment gives the medical team information about your baby’s physical health and helps determine if any special care is needed. Your baby is scored again at five minutes old to look at how baby is adapting to life outside the womb and, if resuscitation attempts were necessary, how your baby has responded. It is not a predictor of neurological outcomes and it’s purpose is strictly to look at the need for and response to resuscitation.
How is my baby scored?
Your baby is assessed in five categories and is given a score from 0 to 2 based on their physical appearance and reactions. While 10 is the highest score, very few babies get it. The reason being that the hands and feet of most babies do not appear the same color as their core until they have had some time to warm up.
At one minute of age, scores ranging from 7 to 10 indicate that only normal care is needed immediately post-delivery. Scores from 4 to 6 indicate that some assistance may be required. The assessment will be performed again at five minutes of life and, if necessary, assistance will be provided at that time. Scores below 4 call for immediate lifesaving measures.
At five minutes, a score from 7 to 10 is considered “normal.” If your baby scores below 7 the medical staff will continue to score your baby every five minutes for up to 20 minutes to assess the needs of your baby.
The APGAR score can be influenced by a number of factors including, but not limited to, maternal sedation, gestational age, trauma, and variability among observers. Your baby’s initial APGAR score may be low if the pregnancy was high risk, labor was difficult, baby was born prematurely, if the mother was given an epidural (or other sedation) or if baby was delivered via C-section.
It is important to remember that lower than normal scores do not mean there will be permanent health problems with your baby, especially if there is improvement in your baby’s score with time. Low scores do not mean your baby is unhealthy, they are simply an indication that further care may be needed, such as suctioning the airway, or oxygen to help the baby breathe better. The medical team will keep you apprised of your baby’s condition if additional support is needed.
It is important to remember that most providers do not consider the APGAR to be perfect, mainly due to observer variability (meaning that one person may assign a score of 6 while another would consider the responses to warrant a score of 7). For this reason the APGAR score is used in conjunction with other assessments to provide a more complete picture of your baby’s adjustment to life outside the womb.