By Silvio Aladjem MD
Prenatal Care was nonexistent at the dawn of the 20th century. The first clinics for prenatal care were opened in Boston in 1900. A few nurses and doctors thought it would be a good idea to see pregnant patients throughout pregnancy. The hope was to be able to detect a rise in blood pressure and make an early diagnosis of toxemia, now known as preeclampsia.. This disease was deadly and anything that could be done to decrease maternal mortality (which in 1900 was 850 per 100,000 birth) was something to consider.
This concept was not welcome by physicians, midwives or the public. You only went to the doctor when you were sick, and you fully expected your pregnancy to be normal. If something was wrong you would not let anyone one know.. This concept, unfortunately, is still alive and well in the minds of a lot of people, who would do anything to dispel the idea that they may have a problem with their pregnancy.
Prenatal Care took 50 years to become established, and by 1950 just about everybody agreed that Prenatal Care was a good idea.
Still, neonatal mortality was high and there was no way to predict, at birth, which infant was going to have a serious problem. In fact, newborns were not seen by a pediatrician until the following day after their birth. Their doctors were not about to come in the middle of the night to examine a baby. Not much they could do anyhow, except to preside over their death, if that was to be.
By the late 40s, doctors at Columbia Medical School, in New York thought that newborns that were unable to spontaneously breath, would benefit from an attempt at resuscitation. That is how a lady anesthesiologist started coming into the delivery room and taking an interest in the newborns and how labor may have affected them
She started by observing the differences between normal term babies with no problems, as opposed to those that could or would not breath on their own. She noted that normal newborns were pink in appearance, their heart rate (pulse) were strong and normal, they were making faces (grimaces) when crying or when lightly stimulated, they were active and breathing fine. The appearance of those that had a problem were not pink, but varied from light pink down to outright blue, their pulse was abnormal, they were not making faces, when lightly stimulated, like a pinch, their activity was pretty much reduced to a minimum or being outright limp, and they were gasping, instead of breathing.
To quantify these observations, she assigned a score of 0 to 2 for each one. (Appearance, Pulse, Grimace, Activity, Respirations). When you add it all up it comes to 10 for the healthy baby and 0 for the dead or nearly dead one, or anything in between. It also came to the acronym of APGAR.
Well, APGAR was more than an acronym. It was her name: VIRGINIA APGAR.
Virginia’s APGAR score was introduced officially in 1952. It had a rocky start and was criticized, vilified, dismissed and questioned in meetings and publications,. However, being simple and effective, it survived and spread like fire around the world, even in remote areas, as an index of how the baby was doing at birth, which had implications on how it would do later.
Virginia Apgar was a pioneer and advocate for children’s well-being. She became associated with March of Dimes, where I had the privilege of meeting her and to be counted among her friends for the rest of her life. In the 70s she wrote the introduction to my textbook to a new branch of medicine known as Perinatology, the branch which covers the prior to birth and immediately after birth medicine.
I believe the word APGAR is the only one that is understood worldwide, no matter what language you speak, and it will remain so. Even today, though, there are some that still don’t know that the APGAR score is not just an acronym, but that it was devised by Dr. Virginia Apgar.
I never understood why she was never given the Nobel Prize in Medicine. Few people in the history of medicine have done or impacted more the care of the newborn, no matter where born, as Virginia Apgar did.
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website, www.drsilvio.com
You can read more of Dr. Aladjem’s posts on Imperfect Women by clicking here. Dr Aladjem also answers questions of medical interest related to pregnancy in a monthly post here at Imperfect Women. You can read more details about this feature and ask a question by filling out the form here.