When a baby is born, their body must switch instantly from depending on the placenta to surviving on its own. The most dramatic change happens in the lungs and heart. Inside the womb, fluid fills the tiny air sacs, and blood bypasses the lungs completely. With the first breath of outside air, the lungs expand, fluid clears away, and blood rushes into the pulmonary vessels to pick up oxygen. Midwives watch this transition closely because any delay in clearing airway fluid or closing fetal shunts can lead to respiratory distress. Keeping the newborn warm during these first critical minutes prevents cold stress, which burns up vital energy stores and causes dangerous metabolic acidosis.
Before doing any detailed physical examination, the midwife performs a quick, life-saving evaluation right on the mother's abdomen or under the radiant warmer. This initial check answers three fast questions: Is the baby term gestation? Is the baby crying or breathing well? Does the baby have good muscle tone? If the answers are yes, the infant stays with the mother for skin-to-skin care and routine drying. If any answer is no, the midwife immediately moves the baby to the resuscitation table to provide warmth, clear the airway if needed, and start life support steps.
Developed by Dr. Virginia Apgar in 1952, the APGAR score is a quick, practical method to evaluate the physical condition of a newborn infant. It provides a standardized numerical scale to check how well the baby tolerated the birthing process and how well they are adapting outside the womb. Each of the five signs receives a score of 0, 1, or 2, making the maximum total score 10. Midwives must remember that the APGAR score is designed to guide immediate resuscitation needs, not to predict long-term neurological health or future intelligence.
The acronym APGAR stands for five distinct physical observations, each graded from zero to two.
Standard clinical practice requires assigning an APGAR score at exactly one minute and five minutes after birth. The one-minute score reflects how well the infant tolerated the stress of labor and delivery. The five-minute score shows how well the baby is adapting to the extrauterine environment and whether resuscitation efforts are succeeding. If the five-minute score remains low below seven, midwives continue assessing the baby every five minutes for up to twenty minutes. Every score must be documented clearly in the labor ward register and the newborn's medical chart.
Interpreting the total score dictates the urgency of nursing and midwifery intervention. A total score between 7 and 10 is considered reassuring, requiring only routine care, warmth, and close observation. Scores ranging from 4 to 6 indicate moderate depression, meaning the baby needs tactile stimulation, airway clearing, and supplemental oxygen. A score from 0 to 3 signifies severe depression and demands immediate resuscitation, including positive pressure ventilation and possible chest compressions. Midwives must remain calm, act quickly according to protocol, and call for pediatric assistance early when low scores appear.