Apgar Score: How It's Done and What's Normal

Your baby is evaluated on her appearance, pulse, grimace, activity, and respiration immediately after delivery. Learn what this Apgar score really means. 
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If you are expecting a baby or recently delivered, you probably heard the word Apgar tossed around and wondered what it meant. Letters and numbers, a score—it can all sound very cryptic. But it's actually just a method of examining newborns right after delivery.

"Apgar is a clinical assessment done in the first minutes of life to determine how well the infant is transitioning to life outside of the womb," explained Terri Major-Kincade, M.D., a board-certified neonatologist in Houston, TX. The Apgar score is determined by the birth team or pediatrician and has 5 components: Appearance, pulse, grimace, activity, and respiration. An infant is scored in his or her first minute outside the womb and again at 5 minutes. In each category, the infant can receive a maximum score of 2. Dr. Virginia Apgar introduced this method of assessing newborns in 1952, but it wasn't until 10 years later that the methodology earned the mnemonic tied to her last name. Let's look at what each letter means for your baby. 

A - Appearance

The first A in Apgar refers to appearance or skin tone. Basically, how pink or blue your baby's skin is. Babies don't start to circulate oxygen-rich blood until after they take their first breath. The oxygenated blood is what makes that blue-ish hue disappear and the pink skin tone to start to take over. A baby who is blue at the 1-minute mark may receive a 0 while a baby who has already turned pink will receive a 2.

P - Pulse

Pulse is the measure of the baby's heart rate and is a measure of the body's ability to pump blood. At one minute after delivery, a baby with a heart rate <100 beats per minute will receive a 1, while a baby with a heart rate of >100 will receive a score of 2.

G - Grimace

Grimace refers to the baby's reflexes. A baby who does not respond to having their throat and mouth suctioned will receive a score of 0; a baby who grimaces or frowns during suction receives a 1, and a baby who grimaces and coughs or sneezes receives a 2.

A - Activity

A baby's activity is its muscle tone or movement. A non-moving baby scores 0, a baby with some amount of arm and leg movement receives a 1, and a baby who is actively moving around and flexing their arms and legs scores a 2.

R - Respiration

The quality of a baby's respiration is determined by their cry. A baby who has not cried at 1 minute post-delivery scores 0, a baby with a weak cry or whimper scores 1, and a baby with a loud cry scores a 2.

What does the Apgar score mean?

Don't worry if your baby doesn't get a perfect 10. Most babies score 8 or 9 on the 1-minute exam. "Scores of 7 and above at the 1-minute mark usually indicates only routine care is needed for the baby," explains Tami Prince, M.D., a practicing OBGYN in Georgia. There are many things that can impact Apgar scoring, including whether or not the baby was delivered vaginally or via C-section. It's also not uncommon for some babies to retain a blue-ish hue in their hands and feet for as long as 10 minutes.

If your baby receives a score lower than a 7, they may need early intervention from doctors. "Intermediate scores of 4 to 6 at the 1-minute exam means that the infant may need some assistance with breathing," Dr. Prince said. "Scores under 4 usually mean that prompt intervention is necessary." Your baby will be re-evaluated at 5 minutes post delivery. Dr. Prince said that a baby with a score less than 7 requires monitoring and retesting at 5-minute intervals until doctors feel the causes (as in why the baby is struggling to breathe) are known, or the issues are resolved. Most infants who receive a low score at birth go on to be happy, healthy babies.  

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