What is an APGAR score? (And Why it's Important)
After the birth of your baby, your birth team will perform a few tests to assess the overall health of your newborn. You may hear references to APGAR scores and other unfamiliar terms right after the birth and wonder what it means. Created by Dr. Virginia Apgar in 1952, APGAR scores are a non-invasive way to make sure your baby is healthy and doing well after birth.
What exactly does APGAR mean?
APGAR is essentially a criteria used by medical professionals to determine how well your baby is doing after birth. It focuses on 5 main areas:
Appearance (Color) - When your baby is born, your birth team will immediately check their skin tone. Is your baby’s skin blue? Pink? Blue skin color can indicate that the baby is not receiving enough oxygen or their heart rate has slowed down, while pink indicates that the baby is generally healthy. In some cases, a baby can have a pink skin color, but their extremities, like their fingers and toes, are blue.
Pulse (Heart Rate) - Your birth team will also note the baby’s heart rate. Does the baby have a heart rate? If so, is it too slow, just right, or too fast?
Grimace (Reflexes) - Your birth team will observe if your baby responds to stimulus. When stimulated, does your baby react? Does your baby cry or grimace?
Activity (Muscle Tone) - How is your baby’s movement? Is the baby limp or active? Does the baby appear to have limited or full joint movement?
Respiration (Breathing) - Is your baby breathing? Does the baby have deep, shaky breaths or does the baby breathe well unassisted? Does the baby appear to need assistance breathing?
Thus, by assessing and observing your baby’s appearance, pulse, grimace, activity, and respiration, your birth team gets a better idea of how your baby is adjusting outside of the womb.
When and where is APGAR testing performed?
Your birth team will perform an APGAR test one minute and five minutes after birth. It can be repeated every five minutes up to twenty minutes. A qualified member of your birth team will perform the test in front of you. After performing the test, your birth team will assign the baby an APGAR score.
How is the APGAR test scored?
Each criteria of the APGAR test is scored as either 0, 1, or 2. 2 is the highest score for each category. A total score is calculated by adding every value assigned to Appearance, Pulse, Grimace, Activity, and Respiration. For example, if your baby gets a score of 2 for Appearance, Pulse, Grimace, Activity, and Respiration, their APGAR score is 10. If your baby receives a score of 1 for each category, they will be assigned an APGAR score of 5.
Cumulative scores ultimately tell your birth team the following:
0-3 are considered critically low scores, particularly for full-term infants.
4-6 are considered below normal scores and may indicate that your baby needs a medical intervention.
7+ are considered normal scores.
For babies who require resuscitation, typical APGAR scoring is not appropriate. Instead, the American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) recommend using an “expanded APGAR score report form”. An expanded form considers that interventions, like resuscitation, were used. Unlike normal APGAR scoring, resuscitated babies receive an “assisted” APGAR score.
How will I know my baby’s APGAR score?
Typically, your care provider will announce the APGAR score after the birth at the 1, 5, 10, 15, and 20 minute mark. By announcing it, the rest of your birth team learns about how the baby is doing as the assessment is performed.
What happens if my baby’s APGAR score is critically low or below normal?
A baby who has a critically low or below normal APGAR score may require some extra help, like an oxygen mask that can be placed over the baby’s face to help them breathe. In some cases, babies with low APGAR scores are taken to the neonatal intensive care unit (NICU) to receive care from specialized providers.
What might cause a low APGAR score?
There are many reasons why your baby might have a low APGAR score. Sometimes, babies do not get all of the oxygen they need during labor. This can occur due to placental abruption (when the placenta separates from the uterus before you have given birth), prolonged labor, uterine rupture (where the uterus tears), and umbilical cord complications among other reasons.
What are the long-term implications of a low APGAR score?
It is important to know that an APGAR score tells you about your baby’s health within a specific time frame. Thus, a low APGAR does not necessarily indicate your baby’s health status in the future. For example, some babies may have a low APGAR score, but still end up healthy and active children. Though very helpful, APGAR scores have some limits and cannot be used to make certain diagnoses alone. Also, many factors can impact an APGAR score, like whether mothers used analgesics or epidurals for pain management or if the baby was born premature. Finally, time can also impact APGAR scores. A baby who has a low score at 1 minute may not have the same score at 5 minutes.
In some cases, an APGAR score that is below normal or critical low at 5 and 10 minute checks may indicate that the baby that has a disability, like cerebral palsy, but further testing is needed before a diagnoses is made.
Bottom Line
APGAR scores are one immediate, non-invasive way to learn about how your baby is faring after birth. For some babies, they are assigned normal scores and for others, they are assigned a score that indicates they need additional support and care. Your birth team will use their APGAR score to determine if interventions are needed and whether it is necessarily to expeditiously recruit care providers from specialities like the NICU. While a low APGAR score can cause some anxiety in new parents, rest assured that other assessments can be performed to verify if there is medical reason for concern.
This information is provided for educational and entertainment purposes only. We do not accept any responsibility for any liability, loss or risk, personal or otherwise, incurred as a consequence, directly or indirectly, from any information or advice contained here.