Virginia Apgar—Scoring Newborns

Parents are generally aware of the Apgar Score used to evaluate newborns, but did you know the name comes from the woman who developed the procedure?

Dr. Virginia Apgar (1909-1974) was a groundbreaker in several areas—studying medicine when few women did, raising the level of anesthesiologists in the medical community, and promoting and improving the health of expectant mothers and babies. She also founded a subspecialty field, perinatology, which is concerned with fetal health and complicated pregnancies.

Virginia Apgar at 20, 1929

But her name is most familiar as a result of the method she developed for evaluating infants immediately after birth.

One of only nine women in a class of ninety at Columbia University's College of Physicians and Surgeons, she graduated in 1933 and went on to specialize in anesthesiolgy. Initially, Apgar wanted to pursue surgery, but a mentor advised her the economic prospects for women surgeons would be poor, especially during the Depression. So she chose anesthesiology instead.

At the time, anesthesia was mostly administered by nurses and was not widely accepted as a specialty for physicians. She spent a year as a resident in anesthesiology at the University of Wisconsin and at Bellevue Hospital in New York. Then, at the age of 29, she became director of a new Division of Anesthesia within the Department of Surgery at Presbyterian Hospital {now New York-Presbyterian Hospital/Columbia University Medical Center). Not only did she develop the new division, but she was the first woman to head a division at Presbyterian. During her eleven years there, she transformed anesthesia service from being staffed by nurses to being performed by physicians. Over time, this transition raised the status and pay of anesthesiologists.

Dr. Virginia Apgar examining an infant

In addition to teaching, she conducted research, taking a special interest in the effects of maternal anesthesia on newborns. When a student asked her how to tell if an infant might need resuscitation, she responded by pointing out five factors—pulse, respiration, muscle tone, color and reflexes. Over the next several years, she refined the test and tracked its use. By 1952, she introduced the method to the broader medical community, and its use expanded. It’s now standard practice worldwide and gets credit for decreasing the mortality of infants in the first 24 hours.

Perhaps the reason most people assume the scale is simply an acronym and not named for a real person is that a medical resident developed a mnemonic device to help remember the five points:

A- Appearance (Color)

P- Pulse (Heart rate)

G- Grimace (Reflex irritability)

A- Activity (Muscle tone)

R- Respiration

A baby is assigned a score from 0 to 2 on each of the five criteria, and infants scoring 3 or less almost always need resuscitation. While the last four items can be measured objectively, Apgar herself admitted that appearance was too subjective to be useful in all cases, especially for babies of color. Some obstetricians have recommended eliminating that criteria and changing it to an 8-point scale.

Apgar initially recommended taking the score at 60 seconds after birth. Others suggested waiting as long as five minutes, but ultimately the standard became scoring the baby both at 60 seconds and five minutes.

In the course of refining the scoring method, Apgar developed an interest in birth defects, their relation to the use of anesthesia during delivery, and the correlation to the Apgar Score.

She took a leave of absence in 1958 to obtain a master’s degree in public health. In 1959, she joined the medical executive staff of the National Foundation for Infantile Paralysis (NF), better known as March of Dimes. Over the next fifteen years, she promoted the need for more research and funding for birth defects. She co-authored a book, Is My Baby Alright?, and appeared on The Phil Donahue Show and other TV and radio programs, as well as publishing scores of scientific articles and essays.

Because of her many accomplishments, Apgar received the following awards:

• Distinguished Service Award from American Society of Anesthesiologists
• Elizabeth Blackwell Medal from American Medical Women's Association
• Alumni Gold Medal for Distinguished Achievement from P & S Alumni Association
• Named Woman of the Year in Science by Ladies Home Journal
• Ralph Waters Award from American Society of Anesthesiologists
• Honored on commemorative U.S. postage stamp in 1994
• Inducted into National Women's Hall of Fame in 1995
• At least three honorary doctorate degrees

Apgar with a viola
she made

In addition to her work, Apgar pursued many other interests. She played violin and built two violins, a viola, and a cello. She was an avid gardener, and was delighted when Harold Patterson, a New Jersey orchid cultivator, named a new orchid in her honor. She enjoyed fly-fishing, golfing, stamp collecting and, in her fifties, took flying lessons.

She never retired, and she continued to teach during her years with the NF. Apgar always carried basic resuscitation equipment wherever she went, saying, "Nobody, but nobody, is going to stop breathing on me!"

Even seventy-five years after developing the scorecard, Virginia Apgar's legacy lives every time a baby is born.

Sources:

Changing the Face of Medicine | VirginiaApgar (nih.gov)
Who Made America? | Innovators | Virginia Apgar (pbs.org)
About this Collection | Virginia Apgar - Profiles in Science (nih.gov)
Update the Apgar Score to remove skin color - STAT (statnews.com)

Photos from Mount Holyoke College. Archives and Special Collections

Multi-award-winning author Marie Wells Coutu finds beauty in surprising places, like undiscovered treasures, old houses, and gnarly trees. After a career writing for newspapers, magazines, state and local governments, and the Billy Graham Evangelistic Association, she returned to her first love—writing fiction—in her fifties. All three books in her Mended Vessels series, contemporary stories based on the lives of biblical women, have won awards in multiple contests. She is currently working on historical romances set in her native western Kentucky in the 1930s and ‘40s. Her historical short story, “All That Glitters,” was included in the 2023 Saturday Evening Post Great American Fiction collection.

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