  I went a long, long time before ever seeing a baby born in the caul (inside the amniotic sac). In hospitals, the membranes are ruptured (broken) somewhere along the way in every birth I have been to.
Even in birth centers, Artificial Rupture of Membranes (AROM) is absolutely commonplace. At Casa, the students need to learn to rupture the membranes (and yes, "rupture" isn't the prettiest word... some say "release" which IS nicer, but absolutely contraindicated in AROM), so we routinely did so... sometimes with our fingers, fingernails (inside gloves), or with the AmniHook... a long crochet-needle looking thing with a beak on the end that snags the bag and breaks it, releasing the water.
(Rupturing membranes is a blogspot unto itself... another day... remind me! ) Then, a midwife at Casa thought it would be a grand idea to see how many babies we could have born in the caul and the game was on. I'd heard about an OB that was so disgusted with AROM that he offered a $50 bounty for every caul birth and shelled out thousands before calling the game... proving that it is possible and isn't dangerous and not AROMing did not slow labors down, but, in fact, helped women cope better.
The first caul birth I saw was so cool! I was doula-ing at UCSD at the Birth Center (on the 4th floor) and the CNM was terrific in wanting to leave things alone. As the baby was being born, it dawned on me that the mom's membranes were still intact; soooo cool! The baby was born with a tight sac on the face and shoulders before the midwife used forceps to break and lift the bag off the baby's face before the first breath.
Another I saw was at Casa. I spent a lot of time there in 2002... about 9 months total that year. There were times I was so exhausted, I could not get up to witness births. My first trip there in 1993, I went to every single birth I possibly could... 90 in 3 months, catching 30 myself. These long months of "getting numbers" in order to sit for the California exam, were exhausting and sometimes I just ignored the "Birth in the Bear Room! " call over the intercom. But, when cool things happened, I was asked to come anyway to photograph.
I always made sure the mom was asked if it was okay before I was awakened because I had shown up once with a camera and a mom was horrified. I left with camera in tow. So, there was a birth happening and the membranes were still intact and someone knew the birth would be something to see. Groggily, I grabbed my camera and went to the birth, watching and taking picture after picture of the most amazing sight; the sac began protruding, water filling up the sac gradually... a slow, s l o w birth where the sac came long before a head did.
I began seeing hair floating in the water behind the amazing amnion and chorion... flecks of vernix swirling around as the head began being able to be seen. I have a picture here: urlLink http://www.picturetrail.com/gallery/view?p=999&amp;gid=4228092&uid=631889&amp;members=1&galleryPassword=emTzTTD1RyAd2&amp; As the baby was born, the bag broke and water spilled onto the bed and the midwife lifted the bag over his face. I loved capturing it on film! One birth here in San Diego, I was the first assist and was behind a kneeling mama with the midwife.
It was cave-dark and we began watching the membranes bulge the perineum. This midwife had not seen a birth in the caul, so I gave whispering instructions about how to manage it so the baby can breathe. When the head is born, it is important to watch for breathing motions because if those happen, it is important to remove the sac from the face. If s/he isn't making a motion to breathe, allowing the body to flow out inside the caul is perfectly fine.
Once the chest is born, removing the sac is imperative since the first inhalation often comes from the release of chest compression from the vagina. I explained about lifting from the chin upwards because two midwives I know had babies aspirate their amniotic sac because it was pulled downwards from forehead to chin and as it came down, the baby inhaled. (Remember how I said we are a product of our experiences? This is a lesson I learned without it happening to me directly!
) So, as she is pushing, we see a darkness in the forward moving sac... vernix? meconium? I had the third assist grab the flashlight and we peered into the sac. Inbetween pushes, the floating stuff settled to the bottom of the "bag" and we had to wait for the next contraction to stir things up again. It was wild to watch! Once the contraction began, we saw that it was, indeed, meconium and pretty darn thick, too.
The midwife asked mom's permission to break the water right before the head was born so she could suction with a DeLee (something we don't do anymore) and mama said, "okay," so we did. I often wonder what that would have looked like to let the baby keep coming in the floating mec pool. Probably safer. As this baby came out, even though the midwife had broken the bag, the amniotic sac was still covering the baby's face. She, however, did not see it! I showed her how it looked like cellophane and that anytime there are late ROM, to check closely to get the face cleared.
She was wide-eyed as I pulled a completely covering film of amniotic sac off the baby's face... chin to forehead. The baby inhaled as I lifted. It is said that babies born in the caul are special or gifted. Various traditions around the world say that the baby will never drown... that the baby will be a midwife... that the baby will have a second sight (a view into the Other Side or psychic powers).
I find, as time goes by, that I touch membranes less and less. I believe they are there for a reason... will break when ready... and serve a purpose we might never know. But, can I tell you quick about how the gift of an amniotic sac helped my partner Sarah after her eye cancer surgery? You see, in hospitals, placentas (with their amniotic sacs) are "donated" by the women. Cosmetic companies and, ever increasingly, medical supply places buy them for a variety of reasons. Many of us feel women should be paid for their placentas, but the hospital considers them donations (tax deductible? I don't think so). Hardly anyone knows about this donation, either. So, many parts to the story that I will eventually blog, but Sarah had to have some lymphoma cut out of her eyeball (in the white, not over the part where she sees) and the surgeons were discussing the surgery and all that it entailed.
They told us that they would graft it (cover it, actually) with one of two things: the foreskin of a circumcised penis or the amnion of an amniotic sac. I could NOT believe, first of all, that they really sold and USED foreskins from babies. She said she could not have that in her eye because then she would be cock-eyed. They didn't laugh. Really, truly, she told them ethically she could not do that. They said fine, amnion it is (there are two pieces to the amniotic sac... the amnion and the chorion... each has its role in the baby department and can be separated, but is very much like sticky cellophane pulling them apart).
They were equally unamused when I offered to bring in swatches of amniotic sacs to see which one matched her eye color best. We thought it was hysterical. After her surgery, we could see this precious gift from an unknowing mom and baby... a centimeter-wide circle that was covering where the cancer had been dug out and sutured with 40 stitches... teeny tiny stitches that she blinked on for several weeks. We both thought of and sent prayers of thanks to this mom and baby that they would give this gift so Sarah's eyeball cells could regrow together, using the amnion as a scaffold to cross and join together as it healed.
Within weeks, the amnion was covered and we couldn't see it anymore. Her body had absorbed it... made it her own. What a miracle our bodies are! 
