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:
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.
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.
The following signs are evaluated by listening with a stethoscope, looking (observation) and touch :
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:
Du Plessis, DW: Juta’s Clinical skills for Midwives, Juta Publishers, Cape Town.