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.
This was an awesome post. When both of my boys were born, I remember them telling me they were doing an APGAR test, but I was out of it, so I didn’t even think to ask what that meant. This cleared that all up 🙂
Amazing! I never knew the story behind this! What a lady!
That is amazing that she stood up and took not and then made a difference. Having a child that had issues during child birth, I am grateful for how far things have come. I might not have him with me today if things were the same as 50 years ago.
Incredible woman! Thank you for sharing this story, it’s amazing!
What a great story, this is something I’ve never heard of before!
I agree! I had never heard of it before
This is an incredibly informative post. I didn’t know any of this. Thank you for letting me know. I feel like this is potentially one if the most educational posts I have read in forever. I am smarter because of it.
I had no idea the story behind the APGAR test. What an incredible woman!
When my babies had the APGAR test I had not the slightest clue what it was myself! Very interesting to read the history behind it.
We are so fortunate to have the care we have today. And I agree she should have received the Nobel Prize!!
That’s amazing! I’m a mom, so I know what the APGAR score is, but I never knew where it came from. It’s amazing to me that prenatal care would have ever been frowned upon. It just goes to show you how much people hate change.
This is grreat info, I had no idea re Virginia Apgar, I too thought it was an anacronym!
Mitch
Oh wow! I never knew the story behind the APGAR score, I just knew that the higher it was, it meant that your baby was ok. I also knew that it was taken twice after birth. Good to know the full story.
Thank God for the evolution of pre natal thinking!
It is so important. Even with access to it today mortality rates around the world are staggering
I never knew that Apgar wasn’t just an acronym! It’s so interesting to learn about people who did great things for science, history, or any other discipline and were left out of common knowledge afterwards.
I remember Apgar score when both my kidlets were born. I had no idea the story behind it or the lady!
Well I definitely learned something new today. I had no idea Apgar was a person’s last name.
I had no idea how it originated. But this is very cool!
This is amazing! I am a VERY greatful momma for all the advances in prenatal care! I had almost lost my son but thanks to all the new technology he is now a beautiful healthy 4 year old!
For some reason I thought the test was named after someone else. I am such a lame brain too because I just finished one of my nursing classes regarding prenatal development. I am pretty sure I am just sleep deprived. I will say this was MUCH more interesting than the material we went over. I wish they shared this with us. What great info and thanks for taking the time to share this with us.
This is so interesting. I remember when each of my kids were born, their apgars were so important to me because they were preemies. Now, I can’t remember what their scores were, but it certainly helped save my childs life because one of them had scores that worsened at the second check.
this is an informative post, and very eye opening because there was a lot that I didn’t know…even after two kids. I am still amazed that my mom had 9 of us with little to no prenatal care. Times were different in Jamaica
I learned about APGAR in school, but never knew the true story behind it! Thanks for sharing that 😀
What an amazing story! We’ll never have any idea how many babies lives she’s saved. You save one life – you save the world! Thanks for inspiring me.
Very interesting post…I agree she should of gotten a Nobel Prize ~ amazing lady!
What a fascinating post – I have to agree I think she should have got a Nobel Prize what a difference she made! x
This is a really great story. I never heard this before!
I was always curious about how APGAR scores came about. Thank you for sharing this article. Great & interesting information for inquiring minds.
So neat to read up on the history of this! I never knew!
That was a great and educational post. I never knew this stuff.
I had fairly uneventful pregnancies. I praise educated docs and good advice
This was an excellent well written post. Thank You for educating me.
I don’t know much about this since I’m kid free but it’s great to read. Thanks for the info.
What’s sad is I am a mom and I don’t recall this test! Thanks for the tips and history.
I never knew that APGAR was a last name. As I saw it in caps, I always assumed it was an acronym. So informative!
I’m so glad that we have much better parental care these days! I almost could have died while pregnant if I didn’t have a good doctor.
What a great story. This is a really interesting post. Thanks for sharing the history.
Very interesting! I was in bed rest with my daughter for three months, I was so afraid she would be so small. This is a great story behind APGAR.
I know what APGAR is but I never knew it was named after it’s creator. This is a very informational article. Thanks!
I never realized that prenatal care had come so far or where the APGAR test originated from. I remember my girls having an APGAR score when they were born.
It seems crazy that I’m so familiar with the test but never knew the woman behind it. Just another example of female awesomeness in history!
It’s crazy how prenatal care is more of a recent thing! It’s so important.
This was so informative. I remember well getting our great APGAR result when my daughter was born and being so relieved to get it.
I remember learning this term when I was pregnant with my older son. I hoped he would get the best score when he was born.
I had no idea APGAR was after a person! I was anxious to hear my kids’ scores when they were born
I had never heard of Virginia Apgar, or APGAR. Great post. Thanks for sharing!
Awesome! Thanks for sharing this. I have no idea what my kids score was.
I love this! When our daughter was born (via csection….she was stubbornly breech)…..I yelled out across the OR…..”what’s her apgar score?”……..thank goodness it was good!
Apgar was one of the first things that we learned for the infant part of nursing school. Not only what it stood for but what each score meant, especially the ones where they just miss going to NICU but still need to be monitored.
Wow this is empowering! Virigina was a pioneer women of the birthing industry and we have her to thank for helping save and monitor the lives of infants for years!
Thanks for sharing! This is amazing – I never knew the story behind the APGAR score.
That is so interesting. I have always wondered where APGAR came from. Thanks for the info.