Originally Posted by ~Caitlyn~
I'd just like to ask... As with any study you have to question the integrity of the underlying data.
I do data analysis (technical data) and this makes me wonder - who reports these apgars? How are they collected? Apgar itself isn't very scientific since it is somewhat up to someone's opinion.
I can't but help but wonder if non-reported stats (typically an issue with hb data) could interfere with this. So- in our state, the parent fills in the 5 minute apgar score when applying for a birth certificate. If you had no idea, you could leave it blank, put in a zero, whatever. Those might seem minor- but I just don't trust the integrity of the data enough to feel like the study is worth reading.
I don't disagree with the statement that hb carries different risks than hospital birth. I just don't feel that this study is very interesting since it is based on such a non-scientific measure (up for interpretation) such as apgar and I question the hardness and actualness of the reporting of that particular metric.
I disagree with your statement that Apgar scores are a "non-scientific measure (up for interpretation)." Apgar scores have pretty strict standards for evaluation, recording, and reporting (at least in hospitals). And everyone follows the same chart - both doctors and midwives. An Apgar score of 0 is both clear and unwanted - I seriously doubt anyone would say that it was 0 if it wasn't 0.
And if the parents were the ones filling out the birth certificate, I can see five scenarios:
1. The parents know their child had an Apgar score of 0 (or other low scores), and they report them as such.
2. Their child had good Apgar scores, they know the exact Apgar scores, and write them down.
3. Their child had good Apgar scores, but they don't know the exact numbers, so they estimate. If that were the case, they wouldn't write down a 0; they would estimate pretty good numbers.
4. Their child had low Apgar scores, but they don't know the exact numbers, so they estimate. Again, in this case, they would probably not put down a 0 - especially for the 5 minute Apgar. They would choose the more hopeful estimation.
5. They don't know the scores at all, so they leave it blank. And non-reported stats (if people just left the spot blank on the birth certificate) were excluded in this study, and so that wouldn't bring the numbers down.
Again, practically no one would report an Apgar score of 0 if the Apgar score was not 0. I think the integrity of this data is pretty solid.
Originally Posted by IdentityCrisisMama
Curious, I googled this and found this article from 2012. http://www.examiner.com/article/home-births-linked-to-seizures-low-apgar-scores
Can someone break Dow what a zero 5 minute apgar is? Is that a still birth? What are thoughts on apgar scores and transfers? That's not something I recall being discussed all that often. MC do you have a set apgar upon which you always transfer?
The wikipedia on Apgar scores is pretty good - http://en.wikipedia.org/wiki/Apgar_score. Apgar scores are assigned out of a scale 0 to 10, based on five different criteria. Infants can score a 0, 1, or 2 on each of the five points (which are appearance/complexion, pulse rate, reflex irritability, activity, and respiratory effort). Scores are usually done at 1 minute after birth and 5 minutes after birth (and sometimes at 10 minutes after).
An infant with a score of zero at 5 minutes means that, at five minutes old, that infant is blue or pale all over, has no pulse, no response to stimulation, no activity, and has no respiratory effort. In a nutshell, no signs of life.
The wikipedia article says "Scores 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low. A low score on the one-minute test may show that the neonate requires medical attention, but is not necessarily an indication that there will be long-term problems, particularly is there is an improvement by the stage of the five-minute test. If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a chance that the child will suffer longer-term neurological damage."
An infant with an Apgar score of zero at five minutes isn't a still birth - it can still possibly be revived and survive (and most do). But, it seriously increases both the possibility of death or of long-term damage.