Your Baby’s Apgar Score: What Is It, and What’s a Good Score?

Your baby’s Apgar score is an evaluation of his condition in his first moments after birth. This article will break down exactly what the Apgar test measures and what the numbers your medical team assigns mean for your baby’s health.

The Apgar score is a simple, rapid assessment tool. It’s used to screen babies to evaluate whether they might need immediate medical assistance (e.g., with their breathing or heartbeat) after being born. It isn’t the only screening tool that doctors use, and is just one of many factors that determine what care your baby will receive.

Your delivery team will test your baby at the 1-minute and 5-minute mark. If your doctor has concerns, your baby will receive more checks. 1

The name “Apgar” is an homage to Dr. Virginia Apgar, who developed the test in 1952 to quickly assess newborns and identify any who need urgent attention. 2 In addition to matching Apgar’s name, the term is also an acronym that stands for:

• Appearance (skin color)
• Pulse (heart rate)
• Grimace (reflexes)
• Activity (muscle tone)
• Respiration (breathing effort)

A doctor, midwife, or nurse will issue your baby a score of 0, 1, or 2 in each category, for a possible maximum of 10. A high score means your baby is adjusting to life outside the womb like a trooper.

Let’s look closer at the key indicators that determine your baby’s Apgar score. 3

Appearance (skin color)

In an ideal scenario, your baby will have a full-color complexion all over when he’s born. It’s normal, however, for him to have a blue tint in his little hands and feet initially. The Apgar assessment features these scores:

• 0: Pale blue all over
• 1: Full-color body, with pale blue hands and feet
• 2: Full color throughout

Pulse (heart rate)

Your doctor will use a stethoscope to check your baby’s heart rate and assign a score of:

• 0: No heartbeat detected
• 1: Heartbeat is less than 100 beats per minute
• 2: Heartbeat is 100 beats per minute or more

Grimace (reflexes)

This category measures your baby’s reflex irritability (i.e., how he responds to stimulation), such as a gentle flick or stroke to the sole of his foot (to check for his Babinski reflex) or airway suctioning.

• 0: No response to stimulation
• 1: Grimacing
• 2: Grimacing with a cough, sneeze, or vigorous cry

Activity (muscle tone)

This point checks your baby’s muscle tone and control and how much he moves.

• 0: Loose, floppy, or inactive muscles
• 1: Some movement of arms and legs
• 2: Active movement with flexed arms and legs

Respiration (breathing effort)

Lastly, your doctor will check how well your baby’s tiny lungs work.

• 0: No breathing
• 1: Slow or irregular breathing with a weak cry
• 2: Good breathing with a strong cry

Once your doctor tallies everything up, your baby will get his Apgar score. Scores often vary slightly from doctor to doctor—this isn’t a perfectly objective test—but here’s what they mean: 4

Again, the Apgar test is subjective. A low score at the 1-minute mark has no impact on your baby’s long-term health outlook. With assistance from the delivery room team, many babies see this number improve to within the normal range by the 5-minute assessment. 5

What does it mean if my baby has a low Apgar score?

Certain factors can negatively impact your baby’s score, such as: 6

• Premature birth
• Difficult labor and delivery
• Unplanned Cesarean section (C-section)
• Fluid in your baby’s airway
• High-risk pregnancy conditions

Certain medications taken during pregnancy can lead to a low Apgar score as well.

What to expect during labor and delivery

While it’s easier said than done, staying calm and listening to your doctor is the best way to go if your baby’s numbers come in a little low.

Your medical team will be right there with you during labor. Ideally, after birth, they’ll follow a normal post-delivery procedure, clamping the umbilical cord after two minutes and then handing your baby to you for skin-to-skin contact. However, if your baby’s Apgar score is low, they’ll take other measures.

They’ll most likely start by drying off and rubbing your baby. If he’s still having a hard time, they might put a mask on him and deliver some breaths into his lungs. If your baby still isn’t breathing well, they may put a tube in his windpipe and send fluid and medications through his umbilical cord. 6

Long-term implications of a poor Apgar score

While doctors previously used Apgar scores to predict long-term outcomes, subsequent research suggests that the metric doesn’t predict future health or neurological problems.

There are many tests your doctor will perform in the delivery room. The results are just one piece of a more extensive health profile, alongside factors like your baby’s gestational age and birth weight. 7

If your baby’s Apgar score still has you on edge, go over the finer points with your doctor or midwife after delivery. You have a team ready to support you and your baby every step of the way, so take advantage!