Bubble boy: Baby born inside intact amniotic sac

"Born in the caul" is a phrase that's connected with a lot of cross-cultural myths and superstitions — babies born in the caul are supposed to be destined for lives of fame and fortune (or, possibly, misfortune and grisly death, depending on which legends you're listening to). Biologically, though, it refers to a baby that's born with part of the amniotic sac — the bubble of fluid a fetus grows in inside the uterus — still attached. Usually, a piece of the sac is draped over the baby's head or face. These are called caul births, and they're rare. But, about once in every 80,000 births, you'll get something truly extraordinary — "en-caul", a baby born inside a completely intact amniotic sac, fluid and all.

There's a photo of a recent en-caul birth making the rounds online. The photo is being attributed to Greek obstetrician Aris Tsigris. It's fascinating. But it's also pretty graphic, so fair warning on that. (If the sight of newborn infants and blood gives you the vapors, you might also want to avoid most of the links in this post, as well.)

Check that shit out. I mean, seriously. That's awesome.

There doesn't seem to be a lot of information on the details of this particular birth, but, most of the time, when a baby is born this way it's also born premature. Sometimes, really premature. There are case reports in medical literature of babies being born en-caul at 23 weeks, 6 days gestation, which, for context, is a little over half the weeks you'd want a baby to gestate. Fetuses aren't large or well-developed enough to even be able to clearly tell their sex on an ultrasound until about 20 weeks gestation.

The premie connection is probably more than coincidence. For one thing, the smaller the fetus, the more space the sac around it has to ballon outward and come through the birth canal intact. What's more, there's evidence that being born en-caul has a protective effect for premature infants. Nobody is exactly sure why. But it might have something to do with the physical mechanics of birth, which, I'm sure you're aware, can be a little rough on both mother and baby. Premies born en-caul essentially come with their own cushiony air bag, which might protect them from physical injuries that could otherwise be life-threatening.

So, in that sense, babies born en-caul really are lucky. Just not in the way the ancient legends would have you believe. In fact, in 1975, a newborn survived for 25 minutes outside the uterus, but inside the fluid-filled amniotic sac, not breathing air, and turned out completely healthy.

Speaking of legends of the caul, back in 1952 The Yale Journal of Biology and Medicine published a manuscript by Thomas Forbes, which collected literary and documentary references to caul-related superstitions dating back to Roman times. I wanted to share one particularly fun story from Forbes' account. This refers to a caul birth, rather than an en-caul birth, so the amniotic sac wasn't totally intact. Instead, just a part of it was draped over the newborn baby's head.

Notes and Queries, that extraordinary repository of antiquarian and other information, offers a quotation from a British newspaper, the Leeds Mercury, for 14 September 1889.

"A laborer's wife bore a son on whose head was a caul. The veil was placed on one side, and no notice was taken of it until some hours after the child's birth. When examined, however, it was found that the words 'British and Foreign Bible Society' were deeply impressed upon the veil. When this discovery was made the greatest excitement prevailed in the neighbourhood, some of the women declaring that nothing short of a miracle had been enacted. The doctor, who inquired into the matter, however, soon explained the affair. The veil, whilst in a pliable condition, had been placed upon a Bible, on the cover of which the words 'British and Foreign Bible Society' were deeply indented. The words were in this way transferred to the veil; but some of the inhabitants still ascribe the affair to supernatural influence..."

Medical Daily has information about the recent Greek birth pictured here. The baby was delivered via c-section and is healthy.
A 2012 case study of another en-caul birth, from the American Journal of Obstetrics and Gynecology. This brief write-up has a photo of the baby, neatly packaged in its bubble.
The Social History of the Caul — Thomas Forbes' 1952 account of the history of caul-related myths and stories.
Wikipedia on the amniotic sac, in case you need more background about what that is and how it works.


  1. Having watched the births of four of my children, it doesn’t gross me out, but that is pretty bizarre! Any word on whether that baby came out OK?

  2. I wonder if en-caul events have become more frequent due to the proliferation of cesarian births?  I took an anatomy class a VERY long time ago that described en-caul births as only vaginal delivery.  I’d guess that cesarian increases the chances? Not sure it matters but it was an interesting flashback…

      1. I’m sure you’re right, it was one class and that this old man took a long time ago.  I was just wondering out loud if there was any correlation.

    1. en caul is not more common with cesareans, unless you are talking about multiple births or extremely preterm births.  for c-sections that are done for a woman already in labor, the water is usually, though not always already broken.  If not, the most common practice is rupturing the sac just after cutting into the uterus as it is easier to reach in and get the baby.  HOWEVER, if you have a very preterm baby, reaching in around the sac and lifting up then breaking the bag is sometimes done to make the process gentler and reduce potential trauma to under-grown babies.   also with twins, sometimes you break the water on the first and deliver, and then the other comes popping up with the bag intact and you can deliver easily that way. 

      1. Because my stupid older brother tried to come out sideways, he was delivered by emergency C-section.  And because of the state of obstetrics in the mid 70s, I was delivered by planned & scheduled C-section 2 weeks prematurely.  Therefore, I’d really like to verify whether I was likely delivered en caul or whether the sac would have been popped first as Reba suggests.  Can anyone confirm this, or Reba, can you cite your source or the nature of your expertise?

        Well, even if I wasn’t delivered en caul, I was still a C-section, so I still have the ability to murder MacBeth according to the witches’ prophecy; and as a Capricorn/Aquarius rising, there are still legends that I am bound for greatness.

        (Plus I was born on New Year’s Eve, which was a tremendous tax boon for my poor parents.  And *obviously* the cause of my bisexuality.)

  3. i’ve personally delivered 2 babies en caul.  i’d bet it is more common in midwife and home births, because breaking water artificially is pretty standard OB practice in hospital as a technique to augment labor progression.  i speculate that that move is probably less commonly done in out-of-hospital settings with a focus on a more ‘natural’ process.

    1. Interesting. I was planning on- and began- a home birth, and the midwives did break the sac. Maybe because it had already been 12 hours of labour and it wasn’t going anywhere fast…

    2. Wait.  So, you’re saying that there’s a good chance of en-caul if the sac doesn’t break on it’s own?  

      1.  no, not saying there’s a *good* chance.  well, by definition, en-caul happens exactly if the sac doesn’t break on its own, or get broken artifically. but that is pretty rare – usually, even without the docs messing around the water breaks at some point in the labor.  we just reduce the chances of it happening even more since we get in there and do it ourselves even when it doesn’t happen naturally.  I’ve done 2 out of about 600 total deliveries.

      2. Not necessarily. I think reba’s referring to the sac breaking before labor really kicks in. Like, your water breaking might not be the first thing to happen in that process. For most people, though, by the time you push the baby out the hole, the sack has ruptured one way or another. 

        1. I was at 9 cm and the sac hadn’t broke yet.   Just got me wondering if the midwife prevented a ‘rare’ event by breaking the sac.

          1. Maybe so.
            I’m a mom who went through a natural birth in a hospital (and that’s a whole other story) and went through the Bradley Birth method. A lot of the stuff I learned in my classes was about nutrition, and I increased my protien intake to build a more resilient amniotic sac, the goal being to deliver the baby with an intact bulb of fluid around it. The thought being that a sac of fluid is easier to get down the birth canal than a head and shoulders. In my case the sac popped early in labor, which was a bit disappointing, but my kid was almost 10 lbs and a week over term.

          2. In my case the sac popped early in labor, which was a bit disappointing 

            My wife is expecting our first in the next few weeks, and I have to say this is the main thing that has kept us from latching too strongly onto any of the natural birthing methods — the fact that many people end up being “disappointed” with the outcome, if they have to end up taking medication, or having their waters break, or whatever.

            For our part, we’re practicing the relaxation techniques and breathing and whatnot, but still quite expecting not to be completely “natural.” I expect that this will still further her prospect of delivering naturally, but that seems better than the disappointment we hear a lot about.

            (Other people’s milage will absolutely vary, of course.)

          3. (Trying to reply to SamSam)
            Being a bit disappointed isn’t bad, it just means adjusting expectations as you go. We made a lot of plans that didn’t quite go as we wanted. For instance, you cannot do certain positions during labor if your blood pressure is high, because you can pass out. Maybe that juice you packed for a little energy will make you puke everywhere. Maybe the nurses will refuse to remove the baby monitor, even if it’s causing intense discomfort.

            Basically, try for natural birth, but don’t do it at home unless you’re SURE of the outcome. And have tarps on everything.

          4. This may sound a little odd, but University of Michigan hospital has a midwife program.  That’s where I gave birth.  And I totally hear you about having to change plans.  I had wanted to do drug-free in the tub, but all the Stage I pain was in my back.  After about 8 hours, I nearly passed out.  Ended up getting an epidural, and 9 hours later entered stage II.  :/  The boy’s left hand was balled into a fist under his chin.  Pretty sure that’s why so much of the labor pain was in my back.  Upshot of not feeling anything is that Stage II can go really fast.  

          5. SamSam, I hear you like woah. (Also, congrats!) This is basically the perspective my husband and I are taking on the creature in my belly. We have an idea of what we would like to do. But we also know that neither of us have ever experienced this before (so we’re essentially pulling these plans out of our asses) and stuff happens all the time that makes your plans irrelevant. 

            I definitely do not want to end up like some of the women I’ve read stories from online who feel like failures or like their whole birth experience was ruined, or like somebody horribly abused them because the process of birth didn’t go exactly according to the plan they had set down ahead of time or the ideology they had bought into. 

            If there’s one thing that doesn’t need extra stress piled on top of it, it’s birth.

  4. Never had a kid, at a pretty distant point from parenthood at the moment, but I thought that photo was pretty fucking awesome and strangely endearing.

  5. Some years ago I responded to an ambulance call for  a baby en caul who was born into a toilet bowl (to a drug-abusing mother).  By the time we arrived, the baby had been in the toilet for maybe 10 minutes.  After lifting the baby out of the toilet, slitting open the amneotic sac, and beginning CPR, the baby survived with no apparent ill effects.  It was one of the crazier things I’ve ever seen.

    1.  If the umbilicus is intact, the baby will still be getting (oxygenated) blood from the placenta for several minutes after birth. Well, or even longer if the placenta itself is still in the mother’s uterus; but I assume in this case it had been expelled.

    2. . . . in 10 minutes, no one took the baby out of the toilet? If you have the presence of mind to call 911, surely you have enough to not leave a baby in a toilet. 

      1. I don’t think the mother was in a fit state to do much; she was in shock and to be fair, she thought the baby was dead.   When I picked it up out of the toilet, its face came right up against the placenta, fully developed.  That was the one moment in my medical career when I thought I was going to be sick.   I laid the baby on some towels, and turned around to get another towel to wrap it up in.  When I turned back around, the baby moved.   I’ve never been so startled in my life.  My partner made the 5-minute trip to the hospital in 59 seconds, and three minutes after our arrival, the baby had his own heartbeat.   Three days later he was off the respirator,  and taking food by mouth.  

        In an interesting twist, I ran into this child, six years later, after I left emergency medicine to become a teacher.  He was a student in my first first-grade class.  I never told him anything about his origins, but it was weird to see him standing there.

  6. Is that hair or exposed cerebellum?  Either way my food budget for the day just shrank.

  7. Wow, this makes sense now. My paternal grandmother was born “with a veil”. Her mother kept it, but her father destroyed it because he believed it would bring bad luck. She was also a fortune teller (read crystal balls, palms, playing cards, etc), so there’s a strong history of superstition and mysticism in that side of my family. Crazy stuff.

    1.  My great-grandmother was born in the caul- she wasn’t a fortune teller, but she believed she had the sight as something connected to that.

  8. The one I always read was that being born “in the caul” conferred the second sight.

  9. My daughter was more-or-less the oppisite of this. My wife’s water breaking was the only sign that labor had started. She then went something like six hours without a single contraction before the docs started pitocin. (27.5 hours of labor, followed by a c-section. Oy.)

  10. In Hungarian folklore, being born with a caul is one of the signs of a taltos, a shaman.  Also being born with a full head of hair or teeth are signs of a taltos.

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