Many amazing events happen during childbirth. But one of the most fascinating is the en caul birth. In an en caul birth, your baby is born inside the amniotic sac or bag of water. This phenomenon has fascinated parents and medical professionals for centuries.1
An en caul birth is considered rare. There are many cultural beliefs and superstitions about this unusual birth. Some people believe that an en caul birth is magical and brings fame and fortune, but there are few benefits or risks. Some parents like to try to have this type of delivery because it is natural and unique.4
When the amniotic sac doesn’t break before your baby is born, you have an en caul birth. A baby born in a bag may also be called a “mermaid birth” or a “veiled birth.” It’s not a good or bad thing. This is unusual.5
Usually, the amniotic sac ruptures before contractions begin or during labor or pushing. The fluid releases and continues to drip until your baby is born. A doctor or midwife may break the bag of water to induce or stimulate labor. If the bag is still intact when you start pushing, it will likely break from the increased pressure created. But if not, you can have an en caul birth.6
“en caul” is different from “caul.” Caul means that a piece of membrane is over your baby’s face, head, or chest when he or she is born, but the bag is not intact. The membrane part may look like a veil or helmet.7
During an en caul birth, your baby is born in what looks like a big squishy water balloon filled with fluid. Usually, one side of the bag delivers the first full load of fluid as it pushes out of your penis. The rest of the sack with your baby’s head and body follows.6
The bag of water has two membranes joined together. You can see through the membranes. Your baby will be curled up in the bag and will get oxygen through the umbilical cord. You can see how your baby is positioned in your uterus before birth.6
When your baby delivers en caul, the doctor, midwife, and nurses will ooh and ahh in admiration and point it out to you. Then, your provider gently cuts the bag with scissors or another instrument or punctures a finger. The water is pouring. The membranes cling to your baby. Your doctor or midwife carefully pulls them away from your baby’s face so he can breathe. Finally, you can hold your baby for the first time. Cutting the cord and how your placenta delivers will be like any other birth.6
Very little information is available about how often an en caul birth occurs. The commonly quoted statistic is less than 1 in 80,000 live births. At this rate, many doctors, nurses, and midwives have never seen an en caul birth.1
Both vaginal and Cesarean births can occur. With a cesarean birth, the surgeon can try to deliver your baby through the bag without breaking it. However, this is not a typical surgical procedure.1
An en caul birth is more likely to have a preterm or small baby. They are also more common if you haven’t had any previous births.1
Domestic births are not tracked at delivery, so any statistics are just an educated guess. I was a midwife for 22 years and a labor and delivery nurse before that. I don’t keep track of how many en caul deliveries I’ve done, but it’s somewhere between 5 and 10 vaginal births. I have delivered over 5,000 babies. These numbers do not correspond to the 1 in 80,000 birth estimate.
Given my numbers, I was curious as to how common en caul births are. So, I surveyed 71 United States nurses, midwives, and OBGYN doctors, and here’s what I found:
- WHO: The survey included 58 labor and delivery nurses, one director of nursing, seven midwives, and five OBGYN physicians. The experience level of those surveyed varied from less than five years to more than 20 years.
- Percentage: Of those surveyed, 80% saw at least one en caul birth.
- Number: There was a wide range in how many en caul births those surveyed had seen, from just one in more than 20 years of experience to “countless” in less than 20 years of experience. Most have seen one or two such births.
What I took from this small survey is that there is a wide range of experience with en caul births. It occurs more than the often reported 1 in 80,000 births. More research will help determine the exact numbers.1
The benefits of an en caul delivery include avoiding the risks that are present when the amniotic sac is ruptured prior to delivery. Risks include the following:2
- uterine infection
- placental abruption, when the placenta separates too early
- umbilical cord compression leading to your baby not being able to tolerate contractions
The most severe, umbilical cord compression occurs with cord prolapse. Prolapse happens when your baby’s umbilical cord falls through your cervix and into the vagina before your baby’s head. The cord gets stuck between your baby’s head and the pelvic bones depriving your baby of oxygen. This almost always leads to an emergency Cesarean delivery.8
Amniotic fluid provides a cushion around your baby. This helps protect her and the umbilical cord from squeezing and bruising during labor and delivery. An en caul birth provides this protection through the birth process.9
An en caul birth has fewer potential complications. A case study found a very low blood cell count (anemia) in a baby born by Cesarean via en caul delivery. But the anemia was probably caused by the abnormal umbilical cord and not the en caul delivery.3
If labor is not progressing, breaking the amniotic sac can stimulate labor. Your provider may recommend an internal fetal heart rate or contraction monitor. Either of these require your water to be released. Expecting an en caul birth may delay the progress of labor or recommended interventions and lead to complications.10
Labor must progress without breaking the amniotic sac to increase your chance of an en caul birth. This means not breaking your water bag to speed things up if everything is progressing normally. Induction of labor can make this difficult. You can still use Pitocin to stimulate contractions if needed.11
Every time you have a cervical check to check your labor progress, your doctor or midwife’s fingers run the risk of breaking the amniotic sac. Limiting vaginal exams can increase your chance of an en caul birth.12
It is important to talk to your doctor or midwife about your wishes. Many doctors routinely break the amniotic sac during childbirth. Even if you reject this intervention, your body may have its own plans, and there’s little you can do to control when your water breaks naturally.
En caul birth is attractive, but there needs to be more research on how common it is or its risks and benefits. When a baby is confined in the amniotic sac, we get a small picture of what life is like in the womb. This is one of the most natural and safe types of birth. But this type of birth is also difficult to plan. Talk to your delivery provider to try this type of birth. It may also be their first time experiencing this kind of unique delivery.
