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OI, Apgar! NO!

RIGHT, time for something less depressing! The Apgar system (named after Virginia Apgar, who invented the thing) is a method used to assess the general state of baby immediately after birth. When baby is born, we look at colour and respiratory effort to check he/she has been through the respiratory and circulatory changes without problems. If all is well, we assess the muscle tone and reflex responses. This is done one minute after birth and then again at five minutes.

A typical Apgar score sheet is shown in Fig 1.


What it means


Well baby


May need medical help


Needs urgent resuscitation

Most babies score 8 or more after 1 minute. The causes of a low Apgar score are mostly respiratory, and oxygen must be given immediately because baby can die or suffer irreversible brain damage. Baby can suffer hypoxia in utero due to compression, poor function or premature separation of the placenta. Drugs taken by mama during labour can also depress respiration.


Fig. 1 An Apgar Score sheet


Score character






Score rating

Heart rate


Slow (below 100)

Over 100


Respiratory effort


Slow, irregular

Good crying


Muscle tone


Some flexion of extremities

Active motion


Reflex irritability

(response to slapping soles of feet)

No response

Some motion




Pale, blue

Body pink, extremities blue

Completely pink


Scored at ...

Min after birth





Note: The bit on postnatal depression isn't a social pack (and neither is the Apgar scale, for that matter!)




"I was like a pond - the surface was calm and the water clear. At the time, my life was going smoothly and nothing was going to stop me. And then it happened - like someone throwing in a rock. For a long time, the ripples spread out across the surface of my pond, affecting everything in my life. It turned everything upside-down."

"But the ripples settled down eventually and disappeared, right? You're calm again - and back to normal."

"Yes, the ripples did fade away and my pond is peaceful again. But it's changed... I've changed. My pond now has a rock in it."


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