Two Apgar figures, sixteen years apart
The figure that circulates comes from 2007 to 2010. The same research group's 2016 to 2023 analysis of the same measure gives roughly one fifth of it. Both are real.
Disclosure first, again. All three studies in this topic are co-authored by the doctor whose name is on this guide: the 2013 analysis, the 2026 one, and the study of home birth after cesarean whose counts appear near the end. That is precisely why all three are printed here rather than only the one that makes the stronger point.
A 5-minute Apgar score of 0 means a baby with no detectable signs of life five minutes after birth. It is rare in every setting and it is recorded on the birth certificate.
The figure that circulates comes from 2007 to 2010 American data, and ACOG reproduces it in its own committee opinion: a 5-minute Apgar of 0 in 1.63 per 1,000 home births with a midwife against 0.16 per 1,000 hospital births, an odds ratio of 10.55 (95% confidence interval 8.62 to 12.93). The same table gives neonatal seizures or serious neurologic dysfunction at 0.86 per 1,000 against 0.22 per 1,000, an odds ratio of 3.80 (2.80 to 5.16).
Now the newer figure. A 2026 analysis of American midwife-attended births from 2016 to 2023 counted them again, this time restricted to home births that were actually intended. The population is single babies born at 37 weeks or later weighing 2,500 g or more. The paper's abstract gives the total as 3,066,021; the three denominators in its own table add up to a slightly larger number, 3,069,961. Both are the paper's own, and this guide prints the abstract figure and tells you the table does not match it.
| 5-minute Apgar of 0, 2016 to 2023 | Babies | Rate as published |
|---|---|---|
| Hospital | 485 / 2,679,689 | 0.02%, about 2 per 10,000 |
| Freestanding birth center | 37 / 155,555 | 0.02%, about 2 per 10,000 |
| Intended home birth | 72 / 234,717 | 0.03%, about 3.1 per 10,000 |
Those differ about five-fold, and the newer one is the lower one. Both were read directly from their sources. A guide published in 2026 that gave you the 2007 to 2010 figure alone, without its date, would be handing you a number that the same research group's own most recent work does not support as current. The two analyses cover different years, and the newer one counts only intended home births, while the older one was keyed on setting and attendant without that split. Whether that is the reason for the gap is a reasonable idea, not a proven one, and no published source states it. So: both figures, both dates, and the honest observation that the recent one is lower.
There is a catch in the newer study, and it is the study's actual point. The 5-minute Apgar score was missing altogether from 3.11% of home birth records, against 1.89% of birth center records and 0.13% of hospital records. Among the scores that were recorded, an Apgar under 4 was seen in 0.26% of home births, 0.20% of birth center births and 0.17% of hospital births. The authors then modelled what would happen if some proportion of the missing scores had been low. Those modelled figures are not printed here for two reasons: they are assumptions rather than observations, and the paper's abstract and its own table give different values for them. The observed rates above are not in dispute; the modelled ones could not be relied on.
If you are considering a home birth after a previous cesarean, there is a separate table with all its counts. Among American planned home births after cesarean from 2007 to 2013, a 5-minute Apgar of 0 occurred in 7 of 6,229 (11.24 per 10,000, about 1 in 890), against 34 of 273,522 hospital vaginal births after cesarean (1.24 per 10,000, about 1 in 8,045) and 241 of 2,575,044 planned repeat cesareans (0.94 per 10,000). Seizures or serious neurologic dysfunction occurred in 8 of 6,510 home cases (12.27 per 10,000) against 30 of 273,401 hospital cases (1.10 per 10,000). Those home figures rest on 7 and 8 events, and the published uncertainty ranges are correspondingly wide, so "1 in 890" is not a precise expectation. ACOG states a third figure from a different study: a recent U.S. study showed that planned home TOLAC was associated with an intrapartum fetal death rate of 2.9 in 1,000, which is higher than the reported rate of 0.13 in 1,000 for planned hospital TOLAC.
"Is there a more recent analysis of the same measure, and what does it say?"
"How often is the Apgar score simply not written down at a home birth?"