After a baby is born, it seems like everyone holds their breath, waiting for that first gusty cry to ring through the room. The doctor suctions goop out the baby's mouth and nose. A nurse rubs warm dry towels on their skin and wipes away fluid. Baby turns from gray and sticky to pink, dry, and screaming for mom.
Anyone who has witnessed a couple dozen births or more begins to get a sixth sense for how a baby is doing when it slides out into the world. But intuition isn't enough. Instead, the labor and delivery team follow a well-established guide to assess baby and make sure everything is going right. This is called an Apgar score.
What Is an Apgar Score?
Before the Apgar score, doctors and midwives would generally eyeball a baby to make sure they were okay after birth. Dr. Virginia Apgar came on the scene in the 1930s and through over 17,000 births honed a standardized method for measuring a newborn's condition. The term APGAR is a pneumonic that stands for appearance, pulse, grimace, activity and respiration.
Your baby's nurse will measure the appearance score on skin color. All babies come out looking a bit purply-red, but as they take their first few breaths of air, their skin gets pink quickly. At one minute, babies should be pink or red all over, except perhaps a bit of blue on their hands and feet. This can vary slightly depending on the baby's ethnicity.
A normal adult heart rate falls anywhere between 60 and 100 beats per minute. However, a newborn's heart rate should be above 100. Babies' hearts beat faster because their body's surface-to-weight ratio is much lower than an adult's, so their heart needs to beat a bit more quickly to keep them warm. If your baby's heart rate falls lower than 100, your nurse wants to know.
Your baby has just come from a nice, warm, quiet womb and has been squeezed like toothpaste into a cold, loud and bright room. They have every right to be annoyed. If your baby is hopping mad at birth, they'll get a high score on this one. If they're a bit too chill, your nurse may lightly pinch their thigh, just to make sure their irritability reflex (yes, that's a real thing) is working.
When your baby is born, your nurse will observe their muscle tone. Are they floppy, or are they kicking those legs and flailing their arms? Floppy babies sometimes need a vigorous back rub or intense drying-off session to tense up those limbs.
Everyone knows that scene in any movie where a woman gives birth. The baby comes out and mom's face is all worry and concern, waiting. Then baby starts blasting out those distinctive newborn cries, and the whole room starts smiling. A baby's cries are an important part of measuring how well they're breathing at birth.
How to Measure an Apgar Score
So how can you measure an Apgar score? You may be picturing a percentage or a letter grade. But an Apgar score can be anything from zero to 10. Zero is worst and 10 is best. Each of the five categories above can score a zero, one or two. Take a look at this chart to see how a baby gets each different score:
Here are a few examples of fictional babies and their scores. Remember the pneumonic: Appearance, Pulse, Grimace, Activity, Respiration.
Baby Eva comes out swinging her arms and kicking her legs (Activity=2). At one minute, her skin is all pink except her little hands and feet which are still blue (Appearance=1). She takes her first breath and starts wailing (Respiration=2). The nurse dries her with a towel and her face scrunches up in frustration (Grimace=2). The doctor reports her heart rate is 115 (Pulse=2). Eva's Apgar is nine, and at the five-minute mark will probably be 10.
Baby Caleb arrives a little floppy but soon starts to move his arms around (Activity=1). At one minute, his feet and hands are still blue. (Appearance=1) At first, Caleb is a quiet little guy, but once he starts crying after 30 seconds, he won't stop (Respiration=2). The doctor starts patting his back and he starts crying even harder (Grimace=2). The nurse listens to his chest and tells the doctor his heart rate is 98 (Pulse=1). Caleb's Apgar score is 7, but after a few minutes of crying and getting his bearings, his score is 10.
Some babies need a little encouragement after birth, and that's just as normal as a baby who scores a 10 at one minute.
What Is a Good Apgar Score?
While 10 is the absolute best score your baby can get, it's pretty unusual to score that at the one-minute mark since most babies are born with blue hands and feet. Most babies fall in the 7-9 range at birth, and anything above six makes your doctor happy.
You'll know your baby's Apgar right away. Their nurse will measure the Apgar at one and five minutes after birth, so the verdict comes in very quickly. Your nurse may not announce the Apgar to the room, especially if baby's looking great, but feel free to ask.
What Is a Low Apgar Score?
A low Apgar score can feel extremely scary. Why is it low? Will the baby be okay? A baby can have a low Apgar score for many reasons and it doesn't always mean something serious is going on. Sometimes babies need a little help getting used to the outside world.
If your baby's Apgar is low, you might see the medical team using these tools to help perk them up:
If the baby does not respond to these measures, they may need additional interventions, like help breathing or intubation.
Apgar Score Statistics
Okay, pregnant people, take a few big deep breaths. That might have been hard to read. You don't want to think about your baby's birth being anything but magical.
Here's the good news: According to a large study reported by the British Medical Journal, only 1% of babies were born with an Apgar less than seven. So, while it's important to be aware of the Apgar and how your new baby will be assessed, rest assured that most babies ace their very first test.