Apgar Score

How does the Apgar score work?

The original Apgar score considers five factors:

• Appearance. This part of the score looks at skin coloration as evidence for blood oxygen levels. Pink skin on your baby’s torso and limbs (if they’re light-skinned) scores highest.
• Pulse. This part of the score hinges on your baby’s heart rate. Babies’ hearts should beat more than 100 times per minute.
• Grimace. Your baby’s provider will use suction on your baby’s nose or mouth to look for reflex irritability. How strongly your baby reacts indicates how responsive they are (more reactivity gets a higher score).
• Activity. How much your baby moves their body can provide a clue to their overall state. The more active they are, the higher the score.
• Respiration. This factors in how well your baby is breathing. Having strong, regular breathing and crying is a positive sign.

Each of the above five criteria can score from 0 to 2. The total score for the test can range from 0 to 10. Higher scores are better. Experts classify the scores like so:

• Reassuring: 7 to 10
• Moderately abnormal: 4 to 6
• Low: 0 to 3

Your baby’s provider will check this score at least twice, at one and five minutes after birth. If your baby’s five-minute score is under 7, they’ll check the score at five-minute intervals until 20 minutes after birth.

In addition to the original Apgar score system, experts now use an expanded version. That version lets providers keep a record of any advanced care your baby received early on.

What if my baby has darker skin?

One of the key limitations of the Apgar score is that it scores pink skin higher but doesn’t account properly for darker skin. Some experts recommend using color from babies’ lips, tongue and gums as being a better indicator. Those areas are a better indicator than skin color itself. But more research is necessary to establish the criteria to score those areas.

What is a normal Apgar score?

An Apgar score of 7 or higher is ideal. Don’t worry if your baby doesn’t score a 10. It isn’t common for babies to have a perfect score because it can take several minutes for their circulation to ramp up after birth.

What happens if my baby’s Apgar score is low?

An Apgar score under 7 means your baby might need supportive care. Some examples of that kind of care include:

• Supplemental oxygen
• Intubation
• Chest compressions
• Medications like epinephrine
• Mechanical ventilation using positive-pressure ventilation (PPV) or neonatal continuous positive airway pressure (NCPAP)

What can cause a low Apgar score?

A low Apgar score means your baby needs more help adjusting to life outside of your uterus. Most low Apgar scores happen because of, or in connection with:

• Cesarean section (C-section) births
• Difficult labor and/or delivery
• Fluid in your baby’s airway
• High-risk pregnancy
• Premature births

Many factors can affect your baby’s transition. And you can’t totally control how your pregnancy, labor and delivery go. Know that it’s not your fault if your baby has a low Apgar score.