The Apgar scoring system was adopted rapidly in the U.S. after 1960, but there were disputes over who should do the actual
scoring. Poch, a pediatrician who had trained with Apgar, thought it should be someone other than the attending obstetrician.
In her response to his letter, she agreed; the person who delivered the baby, whether physician or midwife, was much less
objective and tended to give a higher score.
Number of Image Pages:
1 (84,661 Bytes)
1966-02-25 (February 25, 1966)
Poch, Herbert E.
Saint Elizabeth Hospital
Original Repository: Mount Holyoke College. Archives and Special Collections. Virginia Apgar Papers [MS 0504]
Reproduced with permission of Peter A. Apgar.
Medical Subject Headings (MeSH):
Second Career: The National Foundation-March of Dimes, 1959-1974
Letter from Herbert E. Poch to Virginia Apgar (February 10, 1966)
Do I not remember you as an outstanding student in the anesthesia elective?
I think I can settle your battle. Recently I have been reviewing the records of several hospitals who have been using the
scoring system for years. I am appalled at the scores given by obstetricians to the babies they deliver. The scores are
much too high. The same is true of those given by midwives in Finland, who gave 83% of their babies a score of 10!
Ideally, I think the order of persons assigning the score is 1) a pediatrician (hardly ever present for the actual delivery),
2) anesthesiologist or nurse anesthetist (if there is one), 3) circulating nurse. These nurses are excellent, with much experience
and no personal involvement with that particular baby.
The exact timing for assigning the sore is 60 seconds after both head and feet are visible. Of course if resuscitation is
obviously needed, as with a nonpulsating prolapsed cord, one does not wait at all, let alone 60 seconds, to start ventilation.
The most convenient way to keep track of the 60 seconds is to have a small shelf built, on to which is screwed an automatic
time setter. Have it set for 55 seconds. The nurse starts the timing as soon as both the top of the head and soles of the
feet are visible. Fifty-five seconds later a bell goes off. The score can be decided in 5 seconds, and recorded. All babies
with scores of 4 or under need artificial ventilation in my opinion. Only a few need endotracheal tube -- 1% at Sloane.
If you have other questions, please let me know. Best wishes.