En Caul Birth: What Is It?

Reviewed by Dan Brennan, MD on March 14, 2021

An en caul birth is a rare event where a baby is born still inside an intact amniotic sac. The sac balloons out at birth, with the child remaining inside of the unbroken or partially broken membrane.

What Does It Mean?

The amniotic sac is a thin, fluid-filled sac that surrounds the fetus during pregnancy. This helps protect the fetus from injury and helps regulate temperature so they can stay warm.

The baby sits inside this sac, growing and developing as the pregnancy progresses. Typically, when you're about to go into labor, your amniotic sac bursts (your water breaks). Sometimes, women can go into labor and the sac doesn't burst, causing the baby to be born en caul — completely inside a jelly-like bubble.

This is something that happens by chance. There is no guarantee that it will happen, and it is not necessarily better or worse than a standard birth.

The Importance of Fetal Positioning

Throughout your pregnancy, your baby will move around in the uterus. They generally move freely and try out a variety of positions. The larger your baby becomes, the less room there is for them to move. As your due date approaches, your baby will start to position themselves for childbirth.

Your baby will move down toward your uterus, preparing to go down the birth canal for childbirth. The birth canal is like an expandable tunnel. When you experience contractions during labor, your body stretches this space to make room for your baby to pass through.

For labor, ideally, your baby is positioned head-down, facing its mother's back. Typically your baby will naturally move into this position sometime during the third trimester (between 32 and 36 weeks).

Why Positioning Matters for Childbirth

Your doctor will regularly check the positioning of your baby. During your check-up appointments, the doctor will use their hand to touch your abdomen. They may also do an ultrasound to check the baby’s position.

The goal is always to ensure that you and your baby have a safe delivery. If the baby isn’t in the right position for childbirth, this makes the process more challenging. However, there are a few things you and your doctor might try to reposition your baby:

External cephalic version. This procedure involves two medical professionals where one is lifting up the baby’s buttocks and the other is applying pressure on the mother’s abdomen to the uterus to help rotate the baby’s head forward or backward.

Changing your position. Sometimes you can encourage your baby to change positions by changing your position. You can do this by getting on your hands and knees and rocking back and forth or pushing your hips in the air while laying on your back with your knees bent and your feet flat on the floor.

Stimulating sounds. While in the womb, your baby can hear music, see light changes through your skin, and hear your voice as you talk. Try placing headphones on a certain part of your belly to see if you can interest your baby to move in that direction. You could place a cool washcloth on part of your belly to see if your baby will move away and head downward.

While none of these techniques are guaranteed to work, they're worth a try. Most babies find their way to the right position for childbirth on their own. But you can help them and yourself by staying as relaxed as possible and following guidance from your doctor.

What Happens After an En Caul Birth

If your baby is born en caul, your doctor will carefully and gently start to snip away at the sac to open it. Water will begin to leak out of the sac, kind of like a water-filled balloon with a hole in it.

During childbirth and right after, your baby will have everything it needs. Inside the sac, they have plenty of air and the umbilical cord attached to their belly button is filled with oxygen-rich blood.

The process after that is very similar to standard births. Most babies born with the help of a vacuum will breathe and cry when they’re born. Other babies might be a little stunned and delayed at taking their first breath, especially if they experienced distress during labor.

Your doctor or midwife will be there to help your baby by taking them to a special warming station where they can check to make sure your baby is doing well.

They’ll give you your baby once their breathing is stable. You can request skin-to-skin contact, or have the baby wrapped in warm blankets for you to hold in order to begin bonding. You’ll have a happy, healthy baby eager to see you.

Show Sources


Baby Med: “What Is an ‘En Caul’ Birth?”

Cleveland Clinic: “Fetal Positions for Birth.” 

Healthline Parenthood: “What Is an ‘En Caul’ Birth?”

Johns Hopkins Medicine: “Anatomy: Fetus in Utero.” 

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