A newborn baby’s Apgar score provides a quick summary of the health of the child a minute after it’s born and again at five minutes. Possible scores range from a low of zero to a high of 10. The lower the score, the more the likely the child requires immediate, specialized medical attention.

The number of babies born in the United States outside a hospital has grown in recent years. In 2012, 1.36% of all US babies were born at home, in birthing centers, and other locations rather than hospitals. This is the highest percentage of out-of-hospital births in the US since 1975.

Most out-of-hospital births were attended by a midwife trained to conduct Apgar tests and most of them produced healthy babies with no complications to mother or child. High Apgar scores are used to rate the safety of out-of-hospital births, perhaps contributing to the trend for this method of childbirth.

A recent study of millions of birth records indicates, however, that the high rate of high Apgar scores outside the hospital may generate a false sense of safety. The research team behind the study suggests the inexplicably high number of high Apgar scores assessed by midwives in out-of-hospital settings may represent a lack of training for making Apgar assessments or personal bias on the midwife’s part.

Dr. Amos Grünebaum and his research team analyzed data from the National Center for Health Statistics of the US Centers for Disease Control and Prevention. Grünebaum, a specialist in maternal-fetal medicine, serves as Director of Obstetrics and Chief of Labor and Delivery at the Weill Cornell Medical Center, where he is also a professor of Clinical Obstetrics and Gynecology.

The Grünebaum research team focused its study on 13,830,531 full-term births of single babies weighing 5.5 pounds or more between 2007 and 2010. Each birth was grouped into one of six categories defined by birth setting and birth attendant:

  1. Hospital/physician
  2. Hospital/midwife
  3. Freestanding birth center / certified nurse-midwife (CNM)
  4. Freestanding birth center / non-nurse midwife
  5. Home/CNM
  6. Home/non-nurse midwife

Each baby’s Apgar score was included in the study.

Grünebaum found significantly higher numbers of high Apgar scores coming from midwives and CNMs in home and birthing center deliveries than at hospitals. Highest scores of 10 in 5-minute Apgar test occurred in:

  • 52.63% of birthing center deliveries
  • 52.44% of at-home deliveries

CNMs gave scores of 10 to:

  • 16.43% of the birthing center deliveries
  • 36.9% of home births

In many out-of-hospital childbirth settings, only one birthing attendant is present. When Dr. Virginia Apgar devised the test in 1952, one safeguard she recommended was that someone other than the delivering attendant conduct the Apgar test. This precaution was intended to eliminate personal bias and ensure more accurate assessments.

Source: Grünebaum, Amos, et al. “Justified skepticism about Apgar scoring in out-of-hospital birth settings (abstract).” Journal of Perinatal Medicine. Walter de Gruyter GmbH. Apr 2014. Web. May 9, 2014.