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Baby abnormal at birth?

April 10, 2011

Babies at birth are immediately given a quick health assessment based on a rating system called the Apgar score.   I was shocked when a nursing educator pointed out how this system can mark a baby as abnormal at birth based on the color of its skin.

APGAR is an acronym for different categories and the “A” means appearance. Each category is scored with a 0, 1, or 2, with 2 being the strongest rating.

The highest score in the appearance category goes to babies who “possess a healthy pink skin tone;” such a baby receives the full two point rating.  Hmmm.  As the nursing educator pointed out, if your baby has a skin color that doesn’t show up as pink then, one minute from birth, your baby has the potential to be rated abnormal or unhealthy even if perfectly fine.  Based on her own experience, this happens.

An internet search found that the majority of related sites still use the pink scoring language.  There are some who use from blue-gray color (0) to normal (2) .  This still concerns me as too often “normal” and “typical” are code words for white. People may not intentionally mean that to happen and it does.  In fact, one site used the from blue-gray to normal language for the appearance scale and then in parentheses by normal said hands and feet are pink. We are socialized to believe the dominant culture is the norm.

There has been some movement to use other defining characteristics than pink to assess health appearance for babies of all skin colors.  However, this system, developed in 1949 by Virginia Apgar (a white woman) and used worldwide, has seeped into our consciousness in a way that continues to have impact.

Have you used the phrase “I’m in the pink?”  While there are differing opinions about the origin of the phrase, the meaning of the phrase is often defined as “in perfect condition,”  “in good health”.

There was an interesting comment about the origin of “in the pink of health” on The Hindu, an online edition of India’s National Newspaper:

Another theory is connected with the complexion of Caucasians. Being white, when they are in good health their cheeks are pink in complexion. Therefore, when someone says that he is in the pink of health you can actually see it on the cheeks. Since the cheeks of most Indians don’t turn pink, perhaps we should say, “We are in the brown of health”.  (S. Updendran from the October 18, 2004 edition).

Language has power. Rating systems have power. This example reminds me to be watchful for built-in discriminatory paths that perpetuate a less-than status for those who are not white.

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