THE APGAR SCORE

THE APGAR SCORE

Within seconds of your baby being born and the cord being cut the midwife or doctor will assess her condition according to a standard method known as the Apgar score.

Five vital signs are tested and the baby is given 0,1 or 2 points for each. Heart rate: 1 point is given if it is below 100 beats a minute, and 2 points are given if it is over 100 beats a minute.

Respiratory effort: If breathing is slow or irregular and the baby does not cry, 1 point is given. If the baby cries and her breathing is regular, 2 points are given.

Muscle tone: If the baby makes some movements 1 point is given. If there is good muscle tone with the baby making active movements, 2 points are given.

Reflex acitivity: If the baby responds by grimacing when the nose is suctioned to clear it of mucus she scores 1 point. If she sneezes, coughs or cries she gets 2 points.

Colour: Pink skin tone with blue tinges on the hands and feet would score 1, while pink all over scores 2.

If the first four signs are missing and the baby is blue all over she would not get any points out of a possible 10, and if not helped to breathe the child would be stillborn.

Most babies score 8 or 9 out of 10 on the first scoring as the limbs are usually a little blue during the first minute. A score of 8/10 or more indicates that the baby has not suffered respiratory distress and has received sufficient oxygen during and before birth. A score of between 4 and 7 indicates some breathing difficulties and the baby will be given oxygen (some doctors do this routinely for all babies) and other mild stimulatory measures may be undertaken.

A score of 3 or less indicates severe asphyxia or lack of oxygen and calls for swift action.

This period of separation should be as short as possible and if you can, persuade the staff through your doctor that your baby should be brought to you within an hour of birth. This is a controversial issue and you must do your own lobbying before you have the baby, when you visit the nursing home and through your doctor. The conflict between the need for the child to be with the mother in the period soon after birth which is important for bonding, and the necessity for the child to be observed in the vulnerable hours after delivery, can only be solved by a concerted effort by all concerned. The father, too, should have the opportunity to hold and examine his baby as soon after birth as possible.

While your baby is in the observation nursery she will be examined for any congenital defects, either by your paediatrician or by the hospital staff. Blood tests for anaemia and Rhesus incompatibility (Coombs test) will be done if problems are suspected, and her reflexes and muscle tone will be checked for any signs of damage or congenital abnormality. Her legs should be examined for any signs of clicking in the hip which could indicate congenital hip dislocation. If detected early this condition can usually be treated successfully before the child begins to walk. Between the fifth and seventh day the Guthrie test for

THE APGAR SCORE

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