The APGAR: The First Test Your Baby Takes 
 

As a brand new mom, hearing a “score” of your baby minutes after birth can be alarming. Many parents are not aware of what the APGAR is measuring and the purpose it serves for a newborn.  The APGAR is a test given after birth to evaluate how baby is doing immediately out of the womb. There are a number of misconceptions about the APGAR and in this article we will discuss what an Apgar score means, how to understand the Apgar scale, and when and how your baby will receive an Apgar test. 

What is the APGAR Test?

The APGAR stands for: 
A: Appearance (skin color)
P: Pulse 
G: Grimace responses (aka reflexes) 
A: Activity 
R: Respiration  

The Apgar is given to newborns at 1 minute and 5 minutes after birth. The purpose of the Apgar is to provide the medical team with a view of the baby’s overall physical condition following birth. The Apgar scores of each newborn helps the team to decide if medical care is needed after delivery. Midwives, nurses, OBGYNs and pediatricians use the Apgar to identify babies that may need extra support in oxygen, fluid clearing, blood circulation, or other supports. One example is helping a baby to clear amniotic fluid that may have collected in the lungs following birth. Another example is identifying blueish skin that can mean poor blood circulation in the early minutes of the baby’s life. 

The History of APGAR Scoring

Virginia Apgar, a physician, and anesthesiologist, developed the Apgar test in 1952. Her goal was to quickly evaluate baby’s after they were born to mothers on anesthesia. It then became a newborn evaluation used on all babies. Many doctors have spoken about the importance of distinguishing that this is not meant to be an indicator of long-term health for babies, and what it evaluates is specific to the early minutes after birth.  Some doctors question the reliability of the Apgar because of sensitivity and specificity. It is important for new parents to know that this is one of many tools and the score does not determine long-term impacts on your child.  

Understanding Your Baby’s APGAR Score

The Apgar score is out of 10 points. Each of the 5 sections of the Apgar is rated 0-2. Your baby will receive a score at 1 minute after birth and again at 5 minutes after birth. As an overall benchmark, a score of 7 or above is a mark of good health in the immediate minutes after delivery. If the score is lower, it could indicate a problem that needs attention such as the airways or circulation. When a baby scores less than a 7, the team will continue to evaluation every 5 minutes for 20 minutes. In some cases, immediate intervention may be taken to assist the baby in the transition.  Testing at these two increments allows the medical team to evaluation the baby’s transition from the womb to the newborn stage. 

APGAR Score Chart

As your baby is evaluated in 5 areas, you may want to understand the areas and the scoring. This chart is based on the information provided by American College of Obstetricians and Gynecologists.

Appearance/Color:  
0-Baby is blue or pale 

1- Baby is acrocyanotic 

2- Baby is completely pink  

Pulse/Heart Rate: 
0-Pulse absent 

1- Pulse is less than 100 beats/min 

2- Pulse is greater than 100 beats/min 

Grimace Response/Reflexes
0-No Response 

1-Grimace 

2-Cry or Active Withdraw 

Activity/Muscle Tone
0-Limp 

1-Some Flexion 

2-Active Motion 

Respiration
0-Absent 

1-Weak Cry: Hypoventilation  

2-Good, Crying 

When you deliver your baby, there can be a lot happening in the delivery space. The Apgar is a scoring mechanism that allows the team to see if there are any immediate medical needs as your baby transitions out of the womb. The Apgar is not an indicator of long term health and it does not determine you or your baby’s success during birth and beyond.