The Apgar score for newborns explained and the pioneering woman behind it – Dr Virginia Apgar

The Apgar score has without a doubt saved the lives of countless newborn babies all over the world.

In New Zealand every newborn baby is given the Apgar score within its first few minutes of being born. The Apgar score is a simple assessment of how a baby is doing at birth, and it helps determine whether your newborn is ready to meet the world without additional medical assistance.

The Apgar score has been instrumental in reducing infant mortality rates around the world. Yesterday, June 7, marked the birthday of the woman behind the Apgar score, American obstetrical anesthetist Dr Virginia Apgar.

Dr Virginia Apgar was a leader in her field and to this day, the Apgar score is standard practice in hospitals worldwide. Here we take a look at how the Apgar score works, and we look back on the life of the incredible woman who has without doubt saved the lives of countless babies all over the world.

Dr Virginia Apgar’s Apgar Score is used in hospitals worldwide today.

Who was Dr Virginia Apgar?

Because she was a woman, Dr Apgar endured many near-misses and discouragement in her career.

Born in 1909, the youngest of three children, Virginia Apgar was raised in Westfield New Jersey. Her family was a musical family that “never sat down”. Her father was an insurance executive, but also an amateur inventor and astronomer.

Apgar’s older brother died early from tuberculosis, and her other brother suffered a chronic illness through childhood. Her family’s heath battles, along with a restless sense of curiosity, inspired Apgar to study zoology and then obtain her medical degree.

Apgar began her career in an era when women struggled to enter medicine. She was discouraged by an esteemed medical professor and chair of surgery, Dr Allen Whipple, to follow a career as a surgeon because he had seen many women attempt to be successful surgeons and ultimately fail.

Following Dr Whipple’s advice she continued study in anesthesiology. She eventually became the director of Columbia University’s department of anaesthesia, and in 1949 she became the first woman to become a full-time professor at Columbia University.

Developing the Apgar score

In the 1950s, the US infant mortality rate decreased, but the number of infant deaths within the first 24 hours remained high. The figures disturbed Apgar, who in her work observed infants who were blue or were struggling to breathe were listed as stillborn and left to die. The scientist began investigating methods for decreasing the infant mortality.

Her research led to what is known as the Apgar score which is, even today, a very widely used technique of assessing a newborn’s health.

Thanks in part to Apgar’s work, the death rate for newborns in the US has dropped from one in 30 in the 1950s to one in 500 today.

Dr Apgar never married or had children. She died of cirrhosis of the liver on August 7, 1974.

A nurse tests a newborn’s reflexes as part of the Apgar test. Dr Virgina Apgar invented the scale to quickly assess the health of a baby moments after child-birth.

What is the Apgar test?

The Apgar score is a measure of a newborn’s condition one minute and five minutes after birth.

The test, which was developed by Dr Virginia Apgar in the 1950s, guides midwives, doctors and nurses as to whether a baby needs immediate treatment or monitoring.

Until the Apgar score became common practice, doctors sometimes missed internal problems at birth. It was assumed newborns were healthy unless something was visibly and obviously wrong.

The Apgar score checks five characteristics of a newborn:

  • Skin colour

  • Heart rate

  • Reflexes and responivness

  • Muscle Tone

  • Breathing rate

Each characteristic is rated from 0 to 2, with 2 being the best score. The total gives an Apgar score out of 10. The assessments are taken at one minute after birth and then at five minutes after birth to guide treatment if the newborn’s condition did not sufficiently improve.

What do the Apgar scores mean?

A score of 7 or more is normal. A score of 6 or less at 1 minute and a score of 7 or more at 5 minutes is also normal. However, a score below 7 in the second test at 5 minutes is considered low.

If a baby’s score is low in the first Apgar examination and does not improve by the second test 5 minutes later, doctors and nurses will closely monitor the baby and continue with any necessary treatment or care.

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