The birth of a baby is an exciting time for the parents and the family. For many people, the moment of birth is full of emotions and anxiety, including concerns about the baby’s condition. The process of birth (other than by elective caesarean section) can be a hypoxic experience for the baby, because significant respiratory exchange at the placenta is prevented for a duration of 60–65 seconds during an average contraction. Most babies tolerate this well, but the few that do not may require help to establish normal breathing following birth.

At delivery, the midwife’s initial concern, amongst other things, is usually about the baby’s ability to adapt to the outside world, such as the physiological changes in the heart function and the initiation of respiration. The midwife uses the Apgar scoring system to assess the condition of the baby at birth in the first instance, and then follow up with a full physical examination to confirm normality and to detect any deviation from the norm.

This system helps to rate a baby’s colour, heart rate, reflexes, muscle tone, and respiration with a total score from 0 to 10 (maximum score of 2 for each of the 5 components assessed). Thus, the Apgar score quantifies the clinical signs of the neonate such as cyanosis or pallor, bradycardia, depressed reflex response to stimulation, hypotonia, and apnoea or gasping respirations. Although the Apgar score was named after Virginia Apgar, it is often referred to as an acronym for: Appearance, Pulse, Grimace, Activity, and Respiration.