Terms & Conditions

What is the Apgar Score?

Dr Christine Catling

Dr Christine Catling

Dr Christine Catling, a midwife for over 25 years, is the Director of Midwifery Studies at UTS. She believes research, innovation and good quality midwifery are pivotal to the well-being of mothers and young families. Christine has extensive experience in antenatal education, policy development and research, and has published on workforce issues, homebirth, vaginal birth...
Created on Oct 10, 2023 · 4 mins read

The Apgar score is a system of measurement used by doctors and midwives to evaluate a baby’s health at birth – this can guide them as to whether the baby needs extra care or monitoring.

What is the Apgar score?

The Apgar score is named after American doctor Virginia Apgar and was first introduced in the 1960s as a standardised way of checking a baby’s health after birth, it is checked at both 1 minute and 5 minutes after birth.

While there is some question over whether or not this check is still sufficient, it is still used in hospitals today.

The test is not designed to test for long-term health, and many babies who score low go on to live long, healthy lives, however the test was designed to help doctors/midwives decide if a baby needs closer monitoring or medical assistance immediately after birth (outside of any obvious signs).

How does the test work?

The Apgar score evaluates five key areas of a baby’s well-being:

  1. Appearance (colour): The baby’s skin colour is observed, with a score of 0 for a pale or blue appearance, 1 for a body that is pink but with blue extremities, and 2 for a completely pink body.
  2. Pulse (heart rate): The baby’s heart rate is evaluated, with a score of 0 for no heartbeat, 1 for a heart rate below 100 beats per minute, and 2 for a heart rate above 100 beats per minute.
  3. Grimace (reflex irritability): The baby’s response to stimulation, such as a gentle pinch on the foot, is observed. A score of 0 is given for no response, 1 for a weak grimace or facial movement, and 2 for a strong cry or active response.
  4. Activity (muscle tone): The baby’s muscle tone and activity level are assessed. A score of 0 is given for no movement or muscle tone, 1 for some flexion of arms and legs, and 2 for active motion or strong muscle tone.
  5. Respiration (breathing): The baby’s breathing effort and respiratory rate are evaluated. A score of 0 is given for no breathing, 1 for weak or irregular breathing, and 2 for strong and regular breathing.

So, each of the five areas is assigned a score of 0, 1, or 2. and the scores are then added together to give the overall Apgar score, which ranges from 0 to 10. The test is typically conducted at one minute and five minutes after birth, and sometimes again at 10 minutes if needed.

Doctors look for a score between 7 and 10 to classify the baby as normal, however if the score comes back lower than 7 at 1 minute, and then above it at 5 minutes, that is also considered normal.

The 5-minute test is regarded more importantly than the 1-minute test.

The Apgar score helps doctors and healthcare providers quickly assess the baby’s condition and determine if any immediate medical interventions, such as resuscitation or oxygen administration, are necessary. It provides valuable information about the baby’s transition to life outside the womb and helps guide further medical care. A low Apgar score at five minutes may indicate the need for additional medical attention and monitoring.

What if my baby still scores low after 5 minutes?

There is no need to panic, the Apgar test is just an indicator and it may mean nothing and your baby just needs a little more time to adjust and they will be monitored more closely to ensure nothing is wrong with them and they may re-perform the test at 7 and 10 minutes.

The test is the first indicator for doctors/midwives that there may be something wrong with your baby, so if your baby does not pass after these subsequent tests, they may order further specialised testing.

It’s important to note that the Apgar score is just one part of the overall assessment of a newborn’s health. Other factors, such as the baby’s medical history, gestational age, and physical examination, are also considered by healthcare providers to ensure the well-being of the newborn.

Does the Apgar Score get recorded?

The Apgar score is typically recorded in the baby’s medical record as it allows for continuity of care and helps healthcare providers track the baby’s progress over time. It serves as a baseline assessment and can be referred to in future medical visits or if there are any concerns about the baby’s development or health.

In addition to the Apgar score, the medical record may also include other relevant information, such as birth weight, gestational age, any complications during labour or delivery, newborn screenings, vaccinations, and any other assessments or tests performed on the baby.

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