“Tell Momma all about it”: A tribute to Dr. Virginia Apgar

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The Google Doodle this morning is honoring the birthday of Dr. Virginia Apgar. She was truly one of the most remarkable physicians in the history of medicine. Read her story in Dr. Atul Gawande’s 2006 New Yorker article “The Score”: https://www.newyorker.com/magazine/2006/10/09/the-score

After graduating from the surgical residency at Columbia, she was told by her department chairman, Dr. Allen Whipple (who invented the Whipple procedure and whom Whipple’s triad, but not Whipple’s disease, is named after), that she would not be able to attract patients as a female surgeon. Dr. Whipple instead advised her to pursue anesthesiology.

Dr. Apgar became the 2nd woman in U.S. history to be board-certified in anesthesiology. She expanded anesthesiology into its own division and then its own department at Columbia. Her greatest accomplishment was yet to come.

Her greatest accomplishment, her legacy, was in the Apgar score.

When children are born, they may not be vigorous right away. They can be blue, limp, and/or not crying. Before the 1950s, children born this way were thought to be stillborn or too sick to live, and would be left to die. There was no objective measurement used to determine the condition of newborns.

However, Dr. Apgar didn’t believe it was so simple, and that these children could be resuscitated. It was hard to get obstetricians to listen to an anesthesiologist, and even harder for a woman to get anyone to listen in a male-dominated field in a male-dominated era. So, Dr. Apgar devised a simple scoring system that nurses could use to objectively describe the condition of newborns. Up to two points each could be designated for a baby’s color, heart rate, movement, breathing effort, and crying. Ten points would be a perfect baby. A score of 4 or less would be a blue, limp baby.

With her scoring system in hand, she began to resuscitate them. Sure enough, she found that babies born with a terrible score at 1 minute could have excellent scores by 5 minutes just with oxygen, warming, and stimulation. It took off from there around the world. Doctors, being competitive, actually began trying to devise ways to improve their delivery and newborn resuscitation methods in order to have higher scores. As a result of Dr. Apgar’s work, the rate of “stillbirth” in the United States has dropped by 83% compared to the 1940s.

We say her name on almost a daily basis in pediatrics, but very few of us know her story.

“Do what is right and do it now.” – Dr. Virginia Apgar

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