Your baby's Apgar score shows how well they're doing after birth and whether they need any medical help. A score of 7 to 10 is considered normal.
What is the Apgar score?
It's a simple, numerical assessment that rates how a baby is doing at birth. The Apgar test helps healthcare providers quickly determine whether your newborn might need additional medical assistance.
Anesthesiologist Virginia Apgar, M.D. developed this scoring system in 1952, and modern hospitals worldwide still use the Apgar scale to make an immediate assessment of how ready your baby is to meet the world.
Advertisem*nt | page continues below
While it's your baby's first "test," don't be disappointed if they don't ace it. Many babies just need a little time to adapt to life outside the womb. It's perfectly normal – expected, even – for a baby's hands and feet to not become pink until they're warmed up, for example (see "appearance" in the chart below).
The Apgar score is not used to predict your baby's long-term health, behavior, or intelligence.
When is the Apgar test done?
A healthcare provider (doctor, midwife, or nurse) will assess your baby at one minute and five minutes after birth – after your baby is placed on your abdomen for skin-to-skin contact. Your provider can usually do the tests while your baby is resting on you.
- The one-minute test reflects how well your baby handled delivery
- The five-minute test indicates how well they're doing on their own
Occasionally, the test is repeated every five minutes for up to 20 minutes – for example, if your baby's breathing needs to be monitored.
Learn more about what happens to your baby right after birth.
How is the Apgar score calculated?
Calculating the overall Apgar score is a two-step process.
Advertisem*nt | page continues below
First, the healthcare provider assigns a number from 0 to 2 (see chart below) to describe five Apgar "signs," which include your baby's muscle tone, heart rate, reflexes, color, and respiration.
Dr. Apgar's name is sometimes used as an acronym to remember the signs:
- Activity: how much your baby's moving around, their muscle tone
- Pulse: how well their heart is beating, their heart rate
- Grimace (responsiveness): how their reflexes are working in response to stimulation, such as their airways being suctioned
- Appearance: how much their coloring has pinked up, indicating that their blood is oxygenated
- Respiration: how well they're breathing
Then the five numbers are added together, resulting in a numerical score.
Apgar score chart
This Apgar score chart shows how numerical ratings are assigned to the five Apgar signs that assess a baby's condition at birth.
Advertisem*nt | page continues below
| Apgar sign | 0 | 1 | 2 |
|---|---|---|---|
| Activity (muscle tone) | Limp, no movement, muscles are floppy and loose | Some muscle tone, some flexing of arms and legs | Active, spontaneous motion; flexed arms and legs that resist extension |
| Pulse (heart rate) | No heart rate | Fewer than 100 beats per minute | At least 100 beats per minute |
| Grimace (reflexes) | No response to stimulation | Facial grimace during stimulation | Pulls away, coughs, cries vigorously, or sneezes during stimulation |
| Appearance | Entire body is blue or pale | Good color in body with bluish hands or feet | Good color all over |
| Respiration (breathing) | Not breathing | Slow or irregular breathing, weak cry, whimpering | Normal rate and effort of breathing; good, strong cry |
What's a normal Apgar score?
A score of 7 to 10 is considered normal for both the one-minute and five-minute Apgar tests. A score in this range usually means that your baby's in good shape and doesn't need more than routine post-delivery care.
If you have any questions or are worried, ask your provider about your baby's Apgar score. They can detail for you exactly why your baby received a certain Apgar score and how any concerns are being taken care of.
What does it mean if my baby has a low Apgar score?
One-minute test
An Apgar score lower than 7 means that your baby might need some help. Keep in mind, though, that a low score at one minute after birth doesn't mean that your baby won't be just fine – maybe even by the five-minute test.
If your baby scores between 4 and 6 on the first Apgar test, they may need help breathing. This could mean something as simple as suctioning their nostrils or massaging them, or it could mean giving them oxygen. These measures will likely result in your baby breathing more deeply, so that their five-minute score will be between an 8 and 10.
Advertisem*nt | page continues below
If your baby scores 3 or less on the first Apgar test, they may need immediate lifesaving measures, such as resuscitation and intensive care.
Five-minute test
For the five-minute test, a score of 6 or less may mean that your baby isn't progressing or responding to medical treatment. Your baby may need more medical help. Your provider will determine what steps need to be taken.
What causes a low Apgar score?
Your baby might have a low Apgar score if:
- They were born prematurely.
- They have fluid in their airway.
- They were delivered by C-section.
- You had a high-risk pregnancy.
- You had a complicated labor and delivery. In one large study, a long second stage of labor was associated with an increased risk of a low Apgar score at five minutes.
Advertisem*nt | page continues below
Learn more:
- How long you'll be in the hospital after giving birth
- Newborn screening tests
- The benefits of delayed cord clamping
Was this article helpful?
Yes
No
