NYSSA • The New York State Society of Anesthesiologists, Inc.
NYSSA • The New York State Society of Anesthesiologists, Inc.
Volume 77 Number 2
Dr. Virginia Apgar is a pioneering figure in medicine—not only for her contributions to neonatal care, but also for the resilience and vision that she embodied in a male-dominated field. Her most well-known contribution, the Apgar Score, has become the universal tool for evaluating newborns. Behind this life-saving innovation is a story of determination, adaptability and groundbreaking leadership.
Apgar graduated fourth in her medical school class at Columbia University College of Physicians & Surgeons in 1933.1 She initially aspired to be a surgeon, completing a surgical residency at Columbia University. However, gender inequality presented significant roadblocks. Her mentor, Dr. Allen Whipple, recognized that gender roles and system biases made it difficult for women to break into surgery. He encouraged her to pursue anesthesiology, which was an emerging field with room to grow and contribute meaningfully to surgical care.
“Nobody wanted to go into anesthesia,” Apgar later recalled. “So [Dr. Allen] Whipple said, ‘You do it.’”
Embracing the challenge, she trained under Dr. Ralph Waters at the University of Wisconsin–Madison—the first academic anesthesiology department in the country—where she was the only woman in a class of 16 residents. She then continued her training at Bellevue Hospital in New York under Dr. Emery Rovenstine.
The following year, in 1937, Apgar returned to Columbia to lead the newly formed Division of Anesthesiology, becoming the first woman to head a specialty division at the university. Many surgeons doubted the need for physician anesthesiologists in the operating room—but Apgar persisted, advocating for the specialty’s vital role in patient safety.
Apgar did not just work in a new field. She embodied the spirit of an early adopter, embracing innovation long before others recognized its value. Apgar had all the traits: openness to new ideas, tolerance for risk, intrinsic motivation, visionary thinking and perseverance.
“Nobody, but nobody, is going to stop breathing on me.”
Her decision to enter anesthesiology was a leap of faith. Anesthesiology lacked recognition and structure—but where others saw uncertainty, Apgar saw opportunity. She took risks not for personal gain, but for the chance to build something impactful.
In fact, her visionary mindset led to her most influential contribution. Although the infant mortality rate between the 1930s and 1950s began to decline, Apgar noticed deaths in the first 24 hours after birth remained stubbornly high. She asked a powerful question: How can we quickly and objectively assess a newborn’s condition right after birth to target necessary life-saving interventions?
In 1953, Apgar introduced the Apgar Score—a five-point system to assess a newborn’s health at one and five minutes after birth. It evaluates heart rate, respiratory effort, muscle tone, reflex response and color, each scored from 0 to 2.2
The Apgar Score system required no equipment, was easy to teach and was rapidly adopted in delivery rooms across the country. It remains a global standard today.
Virginia Apgar’s ability to identify an overlooked need and create a scalable, elegant solution marked her as a true innovator. She did not wait for ideal conditions—she acted with insight and urgency.
Beyond the Apgar Score, Dr. Apgar remained a fierce advocate for maternal and infant health. She was among the first to identify the relationship between low Apgar Scores and prematurity, helping draw attention to the risks of early delivery. Her commitment to public health led her to leadership roles for the National Foundation, where she served as Director of Basic Medical Research (1967–1968) and Vice President for Medical Affairs (1971–1974). Dr. Apgar joined the March of Dimes, an organization focused on addressing threats to maternal and infant health.
During the 1965 rubella pandemic, she advocated for vaccination to prevent congenital rubella syndrome. She also promoted Rh screening to reduce pregnancy complications.
Apgar published more than 60 scientific articles, numerous short essays for newspapers and magazines and a book entitled Is My Baby All Right? She was the first to hold a faculty position in teratology at Cornell University School of Medicine. She received numerous awards and honorary doctorates throughout her career and served as an inspiration—even lecturing teens at March of Dimes youth conferences. In 1994, the U.S. Postal Service issued a stamp featuring Dr. Virginia Apgar as part of its Great Americans series.
Dr. Apgar’s contributions are deeply embedded in modern medicine. The Apgar Score continues to save lives, and Apgar serves as a timeless model for innovation.
She succeeded not because her path was easy, but because she embraced change, took bold risks—and never lost sight of her mission to improve care for the most vulnerable. Her legacy reminds us that great change often starts with challenging circumstances, followed by a brave decision and the will to lead where few have gone.
Dr. Virginia Apgar was not just ahead of her time; she helped shape the future. In doing so, she gave generations of newborns a stronger start in life and forever improved the landscape of maternal and infant health.
References
Neha Manchandani is a medical student at the University of Rochester.
Allan Roth is a medical student at Xavier University School of Medicine.
Anna Roth, M.D., specializes in regional anesthesia and acute pain management at South Brooklyn Health.
Richa Sharma, M.D., specializes in regional anesthesia and acute pain management at South Brooklyn Health.
Steven Yap, M.D., MBA, specializes in pain medicine, transplant and major vascular anesthesiology at South Brooklyn Health.
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