Who Was Virginia Apgar

Dr. Virginia Apgar is the woman who developed the APGAR test, a test that your midwife or doctor performs on newborns at one minute of life and again at 5 minutes of life. Dr. Apgar’s work led to an infant assessment procedure that enables midwives and physicians to quickly and accurately assess newborns for distress.

Early Life & Career

Virginia Apgar was born in New Jersey in 1909. One of her early influences may have been her father, an amateur astronomer. Another event that possibly may have helped her see her way to medicine was her infant brother passing away of tuberculosis.

As a student, Virginia rarely sat still, she participated on seven different sports teams, played musical instruments, acted in school productions and wrote regularly. To call her an overachiever is an understatement.

After graduating in 1929, Virginia started at the Columbia University College of Physicians and Surgeons, in a class of ninety students, she was one of only nine women. She graduated near the top of he class in 1933 and took a surgical internship at Presbyterian Hospital. It was during this internship that Dr. Apgar decided to change specialties. She thought that anesthesiology would be a financially favourable specialty particularly in light of the Great Depression and perhaps more socially acceptable given her gender: there are stories of her being told that even a woman wouldn’t go to see a woman surgeon.

At this point in medical history, anaesthesiology was usually performed by nurses under the direction of surgeons and was not yet recognized as a specialty in medical care. Keeping someone asleep and pain free during surgery was a procedure that was still being perfected and because it was usually performed by a nurse, it was considered beneath many doctors.

This attitude would change over time but we’ll get to that.

Advancements in the Field of Anaesthesiology

Dr. Ralph Waters, an early pioneer in Anaesthesiology mentored Dr. Apgar once she finished the Presbyterian nurse anesthesiology course after her 2nd year of the surgical internship.

In 1938 Dr. Apgar returned to Columbia University and Presbyterian Hospital and became the director of Anaesthesiology, making her the first woman to head a division at the hospital. By all accounts, she was a beloved teacher, but as she was the only staff member in the division for some time she found that she had to actually write the textbook for her students to study!

The validity of anaesthesiology as a specialty gradually began to improve and it was finally recognized as such in 1946. In 1949 Dr. Apgar became the first woman to be named a full professor at the Columbia University College of Physicians and Surgeons.

The Apgar Test

During WWII, more women began to birth their babies at the hospital, believing it was a safer environment, however the rate of infant mortality within the first 24 hours remained relatively unchanged. Dr. Apgar began to focus on infant mortality, whether the drugs that she administered played a role in infant mortality, and how doctors could help more newborns survive. She concluded that oxygen deprivation played a huge role in these newborn deaths  and she began to advocate for doctors to look at the babies for signs of oxygen deprivation so that they could administer oxygen if necessary.

Thinking that doctors–being a competitive bunch–might respond well to a simple scoring system, she developed a standardized way to evaluate babies at birth. 

Newborns are evaluated based on 5 criteria: Appearance, Pulse, Grimace, Activity, and Respiration.  Scores are assigned from 0-2 for each criterion for an overall score of up to 10.

Dr. Apgar discovered that babies with a score of 7-10 had a significantly and statistically better chance at survival past the first month of life.

However, the system wasn’t perfect yet.

After a study involving over 1000 births, Dr. Apgar recommended that babies be scored at the one minute of life mark, the 5-minute mark, and (this bit is important) that they be evaluated by someone other than the attending physician. This last part was because she noticed a pattern of OBs scoring the babies that they had delivered higher than others in the delivery room might have done. Building in the objectivity of having the infants scored by another practitioner was an important refinement, and today, the Apgar test is a standard of newborn care the world over. 

Later on, Dr. Apgar would go on to study congenital birth disabilities and was able to show a correlation between an Apgar score and a disability. She became interested in whether some of the congenital issues she was seeing in newborns could be prevented. In 1965, she joined the faculty at the Cornell School of Paediatrics and taught there until 1974. Dr. Apgar was the first person to hold a faculty position dedicated toteratology – the study of congenital disabilities. 

Over the span of her incredible career she published more than 60 papers and a book called Is My Baby Alright? She has received numerous honorary doctorates and accolades and in 1995 was inducted into the US National Women’s Hall of Fame.

Fun Facts:

  • She was known to carry a penknife, an endotracheal tube and a laryngoscope with her at all times just in case someone stopped breathing.
  • APGAR was not an acronym until 1962, when a student renamed aspects of the test to suit the letters in her name, making it easier to remember.
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