There are many physical reasons why a baby can be slow to respond soon after birth and therefore be given a lower Apgar score, usually at one minute of age. These can be any of the following or a combination of these factors.
Fast birth
Cord around the neck
Baby distressed
Narcotic pain relief or a general anaesthetic
Baby is unwell
Fast birth. If the baby descends down the birth canal very rapidly either through a short pushing phase with a natural birth or by a caregiver using a ventouse suction cap or forceps, they may be born a little stunned, taking 2 to 3 minutes to breathe and respond. You may wish to read more in
fast labour and birth.
Cord around the neck. Occasionally the umbilical cord can be around the baby's neck quite tightly, or on very rare occasions wrapped around their neck 2 or 3 times. This can momentarily constrict blood flow to the baby at birth and cause them to take a little longer to respond. Be aware that about 25% of babies are born with the cord around their neck or body loosely, most of the time it doesn't bother them and they have high Apgar scores. You can read more in
Umbilical cord involvement.
Baby distressed. The baby may have been distressed during the labour or just before the birth. Possibly the baby's heart beat was dropping below the normal rate and/or the amniotic fluid was stained green with the baby passing their first bowel movement, called meconium. These signs are not definite predictors that the baby will be slow to respond at birth, but they can increase the chances of this happening. You may wish to read more in
fetal distress.
Narcotic pain relief or a general anaesthetic. Narcotic drugs taken by the mother for pain relief during labour, such as injections of Pethidine, can suppress the baby's ability to take a breath at birth. This is especially the case if the drug was administered within 2 to 4 hours before the birth.