In this blog post I celebrate International Women’s Day by looking at a snapshot of the life of one of the countless amazing, strong and intelligent women in medicine who have shaped the development of today’s medical practice.

Virginia Apgar, From the collection of: National Women's Hall of Fame

Many of you will have heard of the Apgar score. Indeed if you have given birth or supported someone through the process of giving birth you will be well acquainted with the Apgar score! The Apgar score is a test given to newborns to check the baby’s overall health shortly after birth. The test checks the baby's heart rate, muscle tone, and other signs to see if any specific or extra medical attention or emergency treatment is needed. Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they're born. Although the Apgar Score is often veiled in anxiety by new parents awaiting word of their baby’s health, it is recognised as the gold standard for determining the child’s health. Before the Apgar score there was little guidance on assessing and treating infants in their first hours. Many babies were lost who could have been saved.

The Apgar score takes its name from the person who devised it in 1953: Virginia Apgar.

Virginia Apgar was an American physician, obstetrical anaesthesiologist and medical researcher. She was born, youngest of three children in a busy family, in 1909 in Westfield, New Jersey in the United States. She was a talented and ambitious child and was intent on becoming a doctor from a young age.

Dr. Apgar, pictured assessing a newborn baby in 1966.
Image credit: Library of Congress

After graduating in her first degree (in zoology!) she then graduated from Columbia University College of Physicians and Surgeons as an M.D. in 1933. She was one of just nine women in a class of 90. She then hoped to pursue surgery however career opportunities for women in surgery were limited at the time and she was discouraged. So she proceeded to study anaesthesiology instead, becoming the first director of Columbia-Presbyterian Hospital’s new division of anaesthesia in 1938.

Due to the nature of their practice, it's compulsory for Anaesthesiologists to learn resuscitation. Apgar famously said: “Nobody, but nobody, is going to stop breathing on me.” She carried a pocket knife and rubber tubing in case someone needed an emergency tracheotomy, which resulted in her saving 16 lives!

Image credit: National Library of Medicine

In 1949, she became a professor of anaesthesiology at the Columbia University College of Physicians and Surgeons, making her the first ever woman to hold a full professorship at the university. In her professorship she was in a position to focus more of her attention on research. It was during this time that she developed her interest in obstetric anaesthesia, studying the effects of anaesthesia, labour, and delivery on a newborn’s health, which was an understudied field of medicine.

It is said that Apgar created her tremendously influential checklist in response to a question from a student. One morning in 1952, when she was eating breakfast in a hospital cafeteria, a medical student commented on the need for a way to assess how well a baby has endured delivery. Dr. Apgar immediately wrote down five evaluation criteria: breathing, heart rate, muscle tone, reflexes, and skin colour.

Though it may seem that the Apgar score was a spur-of-the-moment creation in a hospital cafeteria, it’s a fact that there was a vast amount of thought and research behind its development.In 1950, there were more than 20 neonatal deaths per 1,000 live births in the United States, and Dr. Apgar was concerned by these figures.

Apgar score on clipboard, From the collection of: National Women's Hall of Fame

Anoxia – primarily due to obstetric anaesthesia – was to blame for most of the neonatal deaths but, in the delivery room, the presence of medical staff trained in anaesthesiology and resuscitation was sparse. Beyond that, there was no consensus on what a “normal” newborn state was or any measures in place to determine which newborns required resuscitation.

Virgina Apgar’s scoring system filled this void, providing five straightforward criteria that clinicians could use to determine a baby’s condition 1 minute after birth and whether they required medical assistance.

Dr. Apgar pointed out that “five [signs] were chosen which could be evaluated without special equipment and could be taught to the delivery room personnel without difficulty.” (V. Apgar, 1966)

The simplicity and effectiveness of the scoring system sat well in what could be a highly strung environment of the delivery room and it is not surprising that it quickly gained popularity worldwide.

In her 50s, Apgar launched a second career, pursuing a master’s degree in public health from Johns Hopkins University and working at the March of Dimes as vice president for medical affairs.

Virginia Apgar the luthier! Image credit: https://quincywhitney.com/apgar-quartet-fiddles-in-the-hospital/

As well as her medical career Apgar played on seven sports teams, acted in plays, wrote for the newspaper, played and built her own violins, so an all-rounder if ever there was one!

Apgar is credited as the founder of the science of perinatology, the branch of medicine that treats the newborn as a patient. Previously viewed as a byproduct of birth, Apgar brought newborns to the centre of care in the delivery room. More than 60 years on, despite significant advances in technology, the Apgar score remains the first medical assessment of a newborn baby.

As stated in the March of Dimes archives: “In essence, the Apgar score was revolutionary because it was the first clinical method to recognise 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 specialised care.”