Virginia Apgar and the March of Dimes
Virginia Apgar, M.D. (1909-1974) was an obstetrical anesthesiologist best known for
developing the “Apgar Score,” a clinical system for evaluating the physical
condition of newborns at birth. Her career spanned the fields of medicine and
public health, and she became a pivotal figure in redirecting the March of
Dimes mission to birth defects, infant mortality, and premature birth in the
1960s. In fact, she was the first medical leader at the March of Dimes to
recognize prematurity as serious problem that demanded a focus on the
importance of early prenatal care and healthy pregnancy. More than that,
Virginia Apgar was an irrepressible and charismatic champion for babies whose wit
and lively personality captivated everyone she encountered in her constant
quest for improvements to infant health.
Born on June 7, 1909 in Westfield, New Jersey, Virginia Apgar attended Mount Holyoke College and studied medicine at the College of Physicians and Surgeons of Columbia University in the 1930s, intending to become a surgeon. Disappointed by the limited career opportunities for women in surgery, she turned to anesthesiology just as it began to develop professionally as a medical specialty. Ultimately, Dr. Apgar headed the division of anesthesiology at Columbia to become the first woman there to hold the position of full professor. Yet her greater achievements were still to come.
At a time when fetal monitors were
not yet invented and babies were given scant attention after labor and delivery,
Dr. Apgar questioned how best to evaluate the newborn infant to improve health
and survival rates, based on her years of experience observing the effects of
anesthesia on mother and child. She created a simple but effective five-point
scoring method designed to focus attention on the newborn to check its vital
signs. Performed immediately after delivery, the Apgar Score measures an
infant’s pulse, skin color, reflex, muscle tone, and respiration, quickly
indicating whether the newborn needs special medical attention to stay alive. In
essence, the Apgar Score was revolutionary because it was the first clinical method
to recognize the newborn as a patient.
The Apgar Score, developed in 1952, is
still in use today throughout the world as a standardized newborn scoring
system, now administered at one minute and five minutes after delivery. Its
effectiveness lies in part in its simplicity, and it continues as a critical
means to predict neonatal survival and reduce infant mortality. Yet as the Apgar
Score stimulated research in diagnosis and treatment of many disorders of the
newborn, Virginia Apgar herself turned to the March of Dimes to satisfy her
career aspirations in the field of public health. In 1959, she joined the
foundation to direct its programs on birth defects prevention, and she
consolidated her reputation not only as a medical leader but as an educator and
publicist about the new mission of the March of Dimes.
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| The original Apgar Score chart with a built in timer. |
Dr. Apgar’s 15 years with the March
of Dimes, 1959 to 1974, were filled with a panorama of activity that encompassed
research, education, program development, and publication. After a severe
epidemic of Rubella (German measles) in 1964 and 1965 that resulted in over
20,000 birth defects and 30,000 neonatal deaths, she initiated March of Dimes
programs for Rubella immunization, urging the passage of a bill that included
appropriations for such immunization before a U.S. Senate committee in 1969. Similarly,
she promoted the optimal use of Rh immune globulin (RhoGAM) among
maternity patients to prevent hemolytic disease of the newborn due to Rh
incompatibility. Always seeking simple but effective improvements in maternal
and child health, she also advocated the development of birth defects
registries and for making genetic history and pregnancy history a routine part
of medical record-keeping on the pregnant mother. Dr. Apgar also capitalized on
the success and popularity of the Apgar Score by featuring it in a March of
Dimes film “Apgar on Apgar” in 1966.
Dr.
Apgar never tired of finding opportunities to focus attention on the well-being
of the neonate in the delivery room, and she always believed it a primary
responsibility to remove the stigma of birth defects in her educational efforts
for the March of Dimes. As the foundation increasingly embraced the new field
of perinatology, Virginia Apgar’s outreach came to embody a pithy March of
Dimes slogan of the 1960s: “Be good to your baby before it is born.” She became
Vice President for Medical Affairs in 1968 and by the end of her career had
authored more than 70 publications on anesthesiology, neonatal resuscitation,
and birth defects. Always attentive to the needs of parents and especially
mothers, she wrote the popular book Is My Baby All Right? (1973), with co-author Joan Beck, to help advance the
understanding of birth defects for a lay audience.
The capstone of Dr. Apgar’s March of
Dimes career led to developments that she might have predicted but did not live
long enough to witness herself. In 1972, Dr. Apgar helped to convene the
Committee on Perinatal Health. A joint effort of the American Medical
Association, the American College of Obstetricians and Gynecologists, the
American Academy of Family Physicians, the American Academy of Pediatrics, and
the March of Dimes, this committee deliberated for four years on a plan to
improve maternal/fetal health and reduce infant mortality. In 1976, the
committee produced the landmark study, Toward
Improving the Outcome of Pregnancy, which set forth a model for the
regionalization of perinatal care in the U.S. Dr. Apgar, however, did not live
to see the implementation of this report as she died in 1974.
Virginia Apgar was recognized internationally as a leader in the prevention of birth defects and infant mortality; her friends and associates also saw her as a caring, enthusiastic physician with super-abundant energy and talents as wide-ranging as piloting an airplane, performing chamber music, and constructing her own musical instruments. In 1994 the U.S. Postal Service memorialized her with a postage stamp issued at a meeting of the American Academy of Pediatrics which in turn honored her by establishing the Virginia Apgar Award in Perinatal Pediatrics. Among her many accomplishments as an anesthesiologist and as a medical director at the March of Dimes, she will surely be remembered for the Apgar Score, of which it is said that every baby is first seen through the eyes of Virginia Apgar.
May 21, 2009 / David
Rose / March of Dimes Archives
