What is meant by the Apgar Score?

Apgar Score


If this is your first baby, you will be quite surprised by your baby’s appearance. Instead of the picture-perfect little angel, your baby will most probably look bluish, and covered with blood and cream-cheese-looking sticky stuff (Vernix).

Your baby will have to pass his first test directly after birth to detect any life-threatening emergencies or abnormalities which require urgent attention.   We use a score chart, called the Apgar Score Assessment, which is a simple assessment of how your baby is doing at birth. It helps us to determine if your baby  is ready to meet the world without additional medical assistance. 

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 each is used to assess a baby’s condition at birth:

Your baby will have to pass his first test directly after birth to detect any life-threatening emergencies or abnormalities which require urgent attention.

Apgar Assesment Scale

The Apgar score is done twice following the birth of the baby. It is done at 1 minute and again 5 minutes after birth. 

This test is a very useful assessment. 

Below is a sample of the chart used for Apgar scoring of the neonate. 

Apgar Score

Click on the chart above to enlarge

The Apgar score is assessed in 5 parts – Heartrate, breathing, reflexes, muscle tone and color. 

Score 0 – 3: Your baby needs resuscitation and will be admitted to ICU.

Score 4 – 7: Your baby needs oxygen (or not), warmth and will be kept under observation, often in an incubator.

Score 7 – 10: Your baby is fine and needs to be held, fed and cuddled.

What are we looking at?

The following signs are evaluated by listening with a stethoscope, looking (observation) and touch :

  1. Heart rate – did you know we can count the heart rate at the base of the umbilical cord?   We do follow it up with listening by means of the stethoscope too as this determines the rate most accurately. During the first 10-15 minutes the heart rate increases to 160-180 per minute.
  2. Respiratory (breathing) effort – During the first 10-15 minutes irregular breathing efforts may be as fast as 60-80 per minute.  Your baby may grunt or may have some (nasal) flaring for a brief period.
  3. Muscle tone – Your baby’s limbs are flexed, and he may wave his arms around.
  4. Response to stimulation – He may cry and there is an increase in muscle tone and motor activity.
  5. Colour – most babies are quite blue at birth and it will take a while for the oxygen to work its way through the limbs.  We don’t like blue lips and tongues though.

What do the Apgar scores mean?

The one-minute Apgar score

The first Apgar score that we allocate at one minute, helps your doctor or midwife decide whether your baby needs immediate medical help, like resuscitation, or not. You may not even notice us allocating his score.

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.  If you had a vaginal delivery, the baby will be on top of your chest during this very important first test.

If your baby scores between 4 and 6, he may need some help breathing. This could mean something as simple as suctioning his nose or mouth or massaging him, or it could mean giving him oxygen by means of a facemask or nasal prongs.  It looks scary, but your baby only needs a little assistance.  He went through a tough time during delivery too. 

If your baby scores 3 or less, he may need immediate lifesaving measures – a full-fledged resuscitation. Keep in mind that a low score at one minute doesn’t mean that your baby won’t be just fine eventually. Babies born prematurely or delivered by caesarean section, for example, sometimes have lower-than-normal scores, especially at one minute.

The Apgar score is usually repeated after 5 minutes and gives an indication of how well your baby is adapting to the outside world. 

The five-minute Apgar score

The second score helps your doctor or midwife 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 doctor or midwife will determine what steps need to be taken.

Follow-up Apgar scores

If your baby had a difficult delivery, or was born prematurely or as an emergency,  a re-assessment after 10 minutes may be necessary.

General information for the new mum:

  1. For all his efforts, your baby will only be allocated a score of 0, 1 or 2 for each of the 5 criteria we assess.  Only in exceptional cases, a score of 10 will be allocated.
  2. A score lower than 7 indicates that your baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother’s womb. 
  3. A low Apgar score is caused by a difficult birth; an emergency caesarean section or when the baby has fluid in the airway.
  4. A baby with a low Apgar score may need oxygen and suctioning by means of a thin plastic tube to clear out the airway to help with breathing and physical stimulation to get the heart beating at a healthy rate. 
  5. Most importantly, a low score at 1 minute is almost always near-normal by 5 minutes. 
  6. A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child. 


Du Plessis, DW: Juta’s Clinical skills for Midwives, Juta Publishers, Cape Town.

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Dr Diana du Plessis

Dr Diana du Plessis

Diana du Plessis is an independent Midwifery consultant and researcher. She specializes in midwifery and neonatology and lectures widely to nursing professionals and academic audiences on a national and international level.

She is a passionate childbirth educator and national spokesperson on breastfeeding. She is the author and co-author of various nursing and midwifery publications (books and peer-reviewed articles).