What Is The Apgar Score? Your Baby's First Health Check Explained

14/08/2014 16:56 | Updated 22 May 2015

Doctor holding crying newborn baby (0-3 months)

Wowee, those first few minutes after your baby arrives in the world can be mind blowing to say the least. While you're completely awash with emotion at having finally seen that screwed up little face and those teeny weeny fingers and toes, your midwife will be performing the Apgar check, to assess your baby's wellbeing.

What is Apgar?

The Apgar scale has been used for decades now – it's a quick, simple and pretty effective assessment of how your baby is doing shortly after their birth, and it will tell the midwife straight away if your baby is in need of a little extra care.

Apgar (which was named after the medic who introduced it) is now an acronym which stands for the specific aspects of health the midwife is looking at, namely your baby's:

• Appearance

• Pulse

• Grimace

• Activity

• Respiration

The check will be performed twice – at one minute after birth (to see how your baby coped with the process of arriving in the world), and at five minutes after birth (to see how well your baby is now doing in their new environment, out of your womb).

Each of the five things above will be given a score of between 0 and 2, to give a total of up to 10.

A baby who scores between eight and 10 is considered to be bouncing, and they'll need only routine care.

A baby who scores between five and seven might need a little bit of help – for example, they might be rubbed vigorously and given some oxygen, to help get their breathing going, and to turn them nice and pink.

A baby who scores below five might need a bit more help than that – they might need to have a short spell under a heated lamp, and to have an oxygen mask. A paediatrician will probably be called to take a look at your baby and assess what they need.

Many babies score between eight and 10 on the first check. Some, who score lower on their first check, might have upped their score by the time they are checked again at five minutes.

Babies who have low scores at both checks will continue to be monitored, as they are given the assistance they need, until they are in a stable condition.

What is the midwife specifically looking for?

Your midwife will give each of the five components a score, based on her assessment of your newborn.

• APPEARANCE refers to your baby's skin colour.

Blue all over scores 0

Pink body, white extremities scores 1

Pink all over scores 2

• PULSE refers to your baby's heart rate.

No heart beat scores 0

Slow heart rate (less than 100 beats per minute) scores 1

Adequate heart rate (more than 100 beats per minute) scores 2

• GRIMACE refers to your baby's reflexes, ie. how they respond to physical stimuli, such as mild pinching (don't worry, your baby won't be hurt, but hopefully a bit annoyed!).

No response scores 0

Grimacing in response to stimuli scores 1

Grimacing plus crying or coughing scores 2

• ACTIVITY refers to your baby's muscle tone and movement.

Limp or floppy scores 0

Some movement and flexing scores 1

Active motion of the limbs scores 2

• RESPIRATION refers to your baby's breathing.

Not breathing scores 0

Slow or irregular breathing scores 1

Breathing well, and crying scores 2

There are some things which are likely to affect a baby's Apgar score. For example, if they were born prematurely, they're much more likely to need a bit of help with breathing. It might have been a difficult birth (or a c-section), or they might have been affected by any pain relief you needed during labour.

A low Apgar score in those very early precious minutes or hours is not any indicator of longer term health issues. The test is designed simply to help medical professionals assess what your baby needs shortly after birth.

And a low Apgar score shortly after your baby is born (if you're even aware of it being done!) is usually no cause for concern. Just rest assured, whatever they score, it'll tell the midwives exactly what they need to do – if anything – to get your beautiful new baby bouncing.

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