Hey guys. I caught an interesting situation the other day and wanted to see how common it really is. We had a 31wk multip being induced for HELLP. Apparently it was going really sl-o-o-o-w, and I, as the NICU delivery person that day, was told in the am that it didn't look like the babe would be coming on my shift. All of a sudden the NICU fellow comes TEARING through my transitional nursery (the room on L&D where we stabilize kids who are going to need NICU care before going to the main unit) shrieking at me to turn on a warmer. A second later she comes back with a limp, apneic 1300g peanut. It turned out MOB had just been checked, had been at 5cm, and a second later started complaining of rectal pressure. Nurse pulls back the blankets and there was baby in the bed, still inside the intact membranes. I've heard of this before, but only with the really wee 400g 23-week kids that just kind of fall out when mom sneezes.
So how often does this happen? Does it happen with term kids too? The baby ended up fine, just needed to be beaten up and suctioned well and then a couple of days of CPAP, but I thought it was interesting.
I have heard people from several different cultural/religious/national backgrounds say that being born with the caul is good and means that the person will have the gift of foresight.
We recently admitted a baby that had been born at home inside an intact sac. Mom had a long substance abuse history and had multiple substances on board on that day. She was G8, abrupted and precipped just before EMS walked in the door. Kid ended up doing very well, but was super cold stressed at first.
The baby I saw was not delivered in the sac but it came close. It was a 40 week multip who said she had an urge to push. I pulled the cover back to check her and all I saw was membranes being delivered. We called the doc for delivery and I sat there holding this sac of water (since we are not allowed to do an arom), hoping it wouldn't rupture all over me.. The doc came in, ruptured her and almost dropped the baby that followed.
I have seen it often in smaller babies, but never in a term infant. One of my patients progressed to pushing while still intact. The sac did not rupture until the head was pretty much even with the ears, when it did rupture everyone in the room 'took a shower' in amniotic fluid. It was pretty gross. But I have always heard it was good luck to deliver en caul. When I deliver I want to have a natural delivery and membranes remaining intact makes contractions much more tolerable, so I am against AROM for myself. I would love to deliver en caul but would hate to give everyone a 'shower' if my membranes rupture during pushing.
Specializes in Cardiac, stroke, telemetry,Med-surgical.
never 'trust' a multip, anything can happen, heck some primip's can misbehave as well..
During my preceptorship in L&D, I had a patient who after an application of Cytotec, delivered a baby in 2 hrs --from closed cervix to full dilation and delivery of a beautiful baby. My preceptor paid attention to woman's complains on heaviness and urge to push and checked her in time; baby was in +1--+2 station.
The patient was primipara.
Later my preceptor said to me, Today you witnessed a power of Cytotec. And now you know what to expect.
Specializes in A little of this & a little of that.
I have seen it often in smaller babies, but never in a term infant. One of my patients progressed to pushing while still intact. The sac did not rupture until the head was pretty much even with the ears, when it did rupture everyone in the room 'took a shower' in amniotic fluid. It was pretty gross. But I have always heard it was good luck to deliver en caul. When I deliver I want to have a natural delivery and membranes remaining intact makes contractions much more tolerable, so I am against AROM for myself. I would love to deliver en caul but would hate to give everyone a 'shower' if my membranes rupture during pushing.
My firstborn was with fully intact membranes @ 42 weeks. I went from 6cm to fully delivered in less than ten minutes. All natural and hurt like heck. My other two, membranes were ruptured during delivery. They were all quick but painful deliveries. I have never heard that intact membranes make contractions more tolerable, it sure didn't for me.
My OB nursing instructor had a few crazy stories to share with us (admittedly easily impressed) nursing students.
One time, as a midwife, she was delivering a baby, and the membranes happened to still be intact as the baby was crowning. She decided it would be really "cool" to deliver en caul. So she's coaching the mom, and as the baby's coming out, she realizes that the membranes Are going to rupture after all. In shock she takes a big deep breath in... and swallows amniotic fluid!
After the class was done dry heaving... she continued her lecture.
That is one lesson you only need to learn once. We often let women labor with an intact bag of water (especially now that Cochran Review demonstrates that AROM is not merited to speed up labor). Most important tip: STAND ASIDE when the Mama starts pushing. You get force behind that taut bag...and watch out! If you are coaching from the foot of the bed, you'll get a shower to remember!
I had this happen to me just a few months ago. Quiet night in the OB unit and my co-worker and I heard a loud disturbance in the hall. Upon checking it out, we found a pt just outside the OB dept that had just delivered a full term infant AND her placenta into the hallway floor. Baby still en caul! Let me tell you, that bag is TOUGH to break with your bare hands. But I did it. This baby was cold stressed too but did fine with a few nights in the special care nursery.
I have heard people from several different cultural/religious/national backgrounds say that being born with the caul is good and means that the person will have the gift of foresight.
Funny that I ran across this thread today. It's my birthday, and my mom likes to tell the story of me being delivered with an intact BOW, essentially a precip delivery. I was her 4th child in 4-1/2 years, so the precip part is no surprise. I've heard that it's good luck, but never knew about the gift of foresight. I don't think I got that :)
BabyLady, BSN, RN
2,300 Posts
Wow..now THAT would be something to see!