The article by Murphy et al., (Anaesthesia 1984; 39 7 S 3 ) recorded the lowest Apgar score at either one or 5 minutes. This is meaningless. Many babies with an Apgar score of less than 3, at one minute have a score of 10.5 minutes after resuscitation. This indicates a less serious state than in those whose Apgar remains low at 5 minutes. It is the later score that bears most relevance to the likelihood of cerebral damage in the infant.' The one-minute Apgar score suffers from the known deficiency of often being mistakenly assessed at the moment of delivery, rather than at one minute of age. The cause of a low Apgar score is what is important to the future of the infant. Central nervous system depression caused by opiates or general anaesthesia is unlikely to be reflected in the cerebral state of the child, given adequate resuscitation of the neonate. However, when the cause of the low Apgar is fetal hypoxia. the implications are more serious. Thus the 1.6% of infants with a low Apgar in the 'no analgesia' or 'gas only' groups are more worrying than three times this number in the pethidine groups. There is no mention in the article, of the number in the epidural group who also received opiates. The lack of correlation between acidosis and low Apgar2 may also be related to the analgesia infants receive, as even those with severe acidosis who received no opiates might be better able to compensate at birth and thus receive a higher Apgar score. Some with no acidosis may have low Apgar scores related to drugs rather than asphyxia. Neither the anaesthetic which mothers received for elective Caesarean section, nor how the adequacy of the lateral tilt was tested is mentioned. Indeed, the final sentence in the paper suggests that some of these mothers may have had uncorrected aortocaval compression. The astonishingly high figure of 30% of these infants with a one or 5-minute Apgar of less than 8 and 5% with Apgar of less than 3, contrasts with the 1984 figures in this unit, where all patients for elective Caesarean sections are meticulously positioned, with an effective lateral tilt, just before incision and 87% receive epidural anaesthesia. Out of 200 normal singletons who weighed more than 2.5 kg, with a cephalic presentation and delivered by elective Caesarean section, none had an Apgar of less than 3 at one minute, 6% of infants after general anaesthesia, and all the remainder were scored at 9 or 10 by the attending paediatrician. One of the many considerable advantages of epidural block for Caesarean section is not only the avoidance of centrally depressant drugs, but also the early detection of aortocaval compression. Caval compression becomes apparent almost immediately and aortic compression is readily revealed on serial auscultation of the fetal heart. Accurate positioning, as well as the aggressive prevention or immediate treatment of even modest hypotension, ensures the avoidance of reduced placental perfusion which is usually the only cause of low Apgar in these normal infants delivered by epidural elective Caesarean section. One might reconsider the necessity of having a paediatrician present in the theatre for epidural elective sections in this group of infants. The Apgar score may indeed by a reflection of fetal asphyxia in modern obstetric anaesthesia, since the minimal use of opiates and general anaesthesia prevents confusion about the cause of central nervous depression in the infants. A study of the possible predictive value of the low 5-minute Apgar score in infants delivered by elective Caesarean section with epidural anaesthesia is needed.