The Apgar score is a way of checking the baby's well-being at one and five minutes after birth. It includes the following five tests: heart rate, breathing, muscle tone, skin colour, and reaction to physical stimulation. It is named after Dr Virginia Apgar, who developed the scoring system using her own name as an acronym.
A = Activity
P = Pulse
G = Grimace
A = Appearance
R = Respiration
Each test is scored 0, 1 or 2 and the scores are added together.
If your baby gets 9 at one minute and 9 at five minutes this is regarded as a top score. Most babies lose a point because of bluish/greyish hands, feet, lips etc.
Most babies score between 7 and 9. Babies with low scores might need extra care, such as help with breathing. A paediatrician is usually called if the Apgar score is low. A baby may be placed "skin-to-skin" on you or your partner, or put in an incubator in the room beside you, to keep them warm; this allows them to concentrate on their breathing. Sick babies, or those needing additional monitoring, will go to the special-care baby unit for observation and treatment. Often low Apgar scores occur because of the circumstances of the birth – e.g. they may have become briefly distressed, or even because of an extremely fast delivery.
Activity - Muscle tone
This test tells the midwife about your baby's muscle tone. A lot of activity and movement scores 2. Some movement of the arms and legs scores 1. Limpness and little or no activity scores 0.
Pulse - Heart rate
The midwife will check the rate of your baby's heartbeat by placing her fingers on the baby’s chest or cord. Over 100 beats per minute scores 2. Less than 100 beats per minutes scores 1.
Grimace - Response to physical stimulation
This test shows how well the baby responds to a stimulus. A cough or a sneeze scores 2, grimacing and whimpering scores 1, silence and no facial response scores 0.
Appearance - Skin colour
The appearance of the skin shows how well the lungs are working and if the blood is getting enough oxygen. In Caucasian babies, the skin should be pink all over to get a full two points. . When checking over Black and Asian babies, the colour of the inside of the mouth, the lips, palms and soles of the feet will also be examined. . Newborn skin is thin, so these babies often look paler and pinker than expected. A point is deducted if the skin is bluish/grey at the hands or feet, or 2 if the skin is bluish or pale all over.
Respiration - Breathing
Regular breathing (and crying) is a sign that the baby has strong, healthy lungs and scores 2. Slow, irregular breathing scores 1.
(An extract from our ebook "Bump to Birth to Baby")