This score — developed by anesthesiologist Virginia Apgar in 1952 and now used in modern hospitals worldwide — rates a baby's appearance, pulse, responsiveness, muscle activity, and breathing with a number between zero and 2 (2 being the strongest rating). The numbers are totaled, and 10 is considered a perfect score.
How does the doctor score my baby?
It's easy to remember what's being tested by thinking of the letters in the name "Apgar": Activity, Pulse, Grimace, Appearance, and Respiration. Here's how they're used to rate your baby:
Activity (muscle tone)
0 — Limp; no movement
1 — Some flexion of arms and legs
2 — Active motion
Pulse (heart rate)
0 — No heart rate
1 — Fewer than 100 beats per minute
2 — At least 100 beats per minute
Grimace (reflex response)
0 — No response to airways being suctioned
1 — Grimace during suctioning
2 — Grimace and pull away, cough, or sneeze during suctioning
0 — The baby's whole body is completely bluish-gray or pale
1 — Good color in body with bluish hands or feet
2 — Good color all over
0 — Not breathing
1 — Weak cry; may sound like whimpering, slow or irregular breathing
2 — Good, strong cry; normal rate and effort of breathing
What do the Apgar scores mean?
The one-minute Apgar score
This helps your practitioner decide whether your baby needs immediate medical help. If your baby scores between 7 and 10, it usually means he's in good shape and doesn't need more than routine post-delivery care. (dont't be disappointed if your baby doesn't score a perfect 10, though. It's unusual for a baby's hands and feet to have good color one minute or so after arrival.)
If your baby scores between 4 and 6, he may need some help breathing. This could mean something as simple as suctioning his nostrils or massaging him, or it could mean giving him oxygen. If your baby scores 3 or less, he may need immediate lifesaving measures, such as resuscitation. Keep in mind, though, that a low score at one minute doesn't mean that your baby won't eventually be just fine. Sometimes babies born prematurely or delivered by cesarean section, for example, have lower-than-normal scores, especially at the one-minute testing.
The five-minute Apgar score
This helps your practitioner see how your baby is progressing and whether he has responded to any initial medical intervention. A score of 7 to 10 is still considered normal at this point. If your baby scores 6 or less at the five-minute mark, he may need medical help and your practitioner will determine what steps need to be taken.