Tuesday, October 10, 2006

What's Your Apgar Score?

For those of you who haven't read it, The New Yorker's latest issue includes an article about the industrialization of childbirth ("The Score," by Atul Gawande). It's a refreshingly non-judgmental approach, written by a surgeon, and includes the history of obstetrics and an explanation for the prevalence of non-emergency C-section deliveries. All fascinating stuff. It doesn't judge doctors or patients, just presents the history of obstetrics-related phenomena from a surgeon's perspective.

One thing that really blew me away was learning about the birth of the Apgar score. As many of you will recall, the Apgar is the score that your baby gets at one minute and five minutes after birth, rating such things as color, breathing, crying, etc. Apparently, before there was such a thing to standardize the way doctors chose to treat (or not treat, as the case may be) infants upon their arrival in the world, the obstetrician would decide subjectively whether the baby was worth saving or not. As we now know, a baby's Apgar score can be very low at one minute and very high at five, particularly if steps have been taken to improve breathing and body temperature right away. Babies were, if I am to believe this writer, simply left to die if they were born blue, too small, or malformed. A woman named Virginia Apgar, an anasthesiologist in the 1950's, was so appalled at this practice that she devised a score for nurses to rate the condition of newborns.

The Apgar score changed everything. Suddenly all kinds of new data were being observed and collected about newborns, and now there was a way to measure - with a number - how an infant was doing at one and five minutes. It measured color (blue or pink), heart rate, vigorous breaths, and movement of all four limbs. These numbers could be compared and used as learning tools for doctors. Neonatal intensive-care units appeared. Prenatal ultrasound became common. Fetal heart monitors became standard. As Gawande, points out, hundreds of adjustments were made in the practice of obstetrics over the years since, to produce what is now called "the obstetrics package."

Ok, so the average hospital birth is full of things that most of us would rather not deal with. I don't even want to get into whether a hospital birth is bad or good, whether it's best to go with a midwife at home (back in the days when doctors didn't wash their hands between performing autopsies and examining delivering mothers, that was definitely your best option) or submit to a totally medical experience when one may not be necessary. What about what happens later?

What was your score one day after giving birth, and five days after giving birth? What about five months after? How can anyone tell? Who is to rate a mother's well-being? It seems an important part of the equation is being left out here. I believe that unless a mother is actively crying all day and night or talking about killing herself, people tend to look past us to the infant. Or just look past us.

What if there was an Apgar score for moms? What kinds of things would you want rated? What could be done to maintain your health and sanity after childbirth, and into the early years?


Anonymous said...

Hmmm...that's a tough one, I was extatic when L was born. I was very happy, had th ebaby blues a little but it went away really fast. I was really anxious her first year. I was so focused on sleeping that it would keep me up nights! But I was happy. I was also happy with D, I didn't really cry or get weepy. After I got home from the hospital I started to get really stressed out. L had become a very strong willed feisty kid, fun but really hard to deal with. I was overwhelmed with 2 kids so young and I think that was when things went down holl for quite sometime...I really don't remember much of the first year and not much of the second. I was so lucky to have family and a wondrful husband to help. I feel like now I amdoing better, I have good and bad days. The good days I am ready for another one and on the bad days it is enought to make me want to throw up just thinking about it.

Anonymous said...

Here are a few thoughts while typing one handed: # of times I accepted help from friends & family; frequency of showering (direct link to my well being); time spent outside, preferably on a sunny day; minutes spent alone (another direct link to my well being); time spent talking with cool mommy friends who help me maintain perspective; pecentage of wardrobe being worn that is still matenity clothes; minutes spent talking to my husband without children awake; Number of insensitive, idiotic comments from people about anything--baby's size, my size, the labor/birth, etc. Hmmm...apparently I have some thoughts on this subject! Being 8 weeks post-partum I am feeling some distance from that intense early time. Whew! Thanks for talking me down off the ledge a few times!