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The Woman Behind the Apgar Score

Virginia Apgar was an obstetrical anesthesiologist best known for developing the Apgar score, a system used worldwide for evaluating the physical condition of newborns at birth. Born on June 7th, 1909 in Westfield, New Jersey, Apgar attended Mount Holyoke College in Massachusetts and studied medicine at the College of Physicians and Surgeons of Columbia University in New York with hopes of becoming a surgeon. She turned to anesthesiology due to the lack of opportunities for women to become surgeons during the time period. As a result, in 1949, when anesthesia research became an academic department, Dr. Apgar was appointed the first woman full professor at the Columbia University College of Physicians and Surgeons.

By the early 1950s, Apgar had years of experience observing the effects of anesthesia on mothers and children during labor and delivery. During this time, she began to question how best to evaluate newborn infants to improve health and survival rates. In 1952, she created a simple but effective five-point scoring method designed to focus attention on the newborn’s vital signs. This method, known as The Apgar Score, was the first standardized method for evaluating the newborn’s transition to life outside the womb.

In her medical journal, “Evaluation of the Newborn Infant-Second Report,” Apgar explains, “Five points- heart rate, respiratory effort, muscle tone, reflex response, and color- are observed and given 0, 1, or 2 points. The points are then totaled to arrive at the baby’s score.” This score was presented in 1952 at a scientific meeting and was first published in 1953, becoming became the first clinical method to recognize the newborn’s needs as a patient. It helped spur the development of neonatology as a medical focus, establishing the need for protocols and facilities such as the newborn intensive care unit to provide specialized care.

Apgar first planned for the score to be taken one minute after birth as a guide to the need for resuscitation. Others after her began to take measurements at longer intervals to evaluate how the baby had responded to any necessary resuscitation. Hence, the one-and five-minute Apgar Score became standard.

Eventually, Apgar went on to relate the score more closely to the effects of labor, delivery, and maternal anesthetics on the baby’s condition. In 1963, the acronym APGAR was coined for the scoring system as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. The Apgar score is still in use today throughout the world as a standardized newborn scoring system.

In 1959, while on sabbatical leave, Apgar earned a master’s degree in public health from Johns Hopkins University. Deciding not to return to academia, she became the director of the division of congenital defects at the National Foundation for Infantile Paralysis, founded by President Franklin Delano Roosevelt (now the March of Dimes).

Virginia Apgar is widely renowned for devoting herself to the prevention of birth defects through public education and fundraising for research. She received many honors and awards for her work, including two honorary doctorates from Mount Holyoke College and the Women’s Medical College of Pennsylvania. Apgar has continued to earn posthumous recognition for her contributions and achievements: in 1994, for instance, she was honored by the United States Postal Service with a 20¢ Great Americans series postage stamp. In November 1995, she was inducted into the National Women’s Hall of Fame in Seneca Falls, New York, and in 1999, she was designated a Women’s History Month Honoree by the National Women’s History Project.

Virginia Apgar not only helped broaden the field of medicine, but also likely helped save the lives of dozens of children. Her work cannot be underestimated, and we should honor her with the likes of other great medical innovators throughout history.

Featured Image by Mario Antonio Pena Zapatería on Flickr

Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

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