What Is en Caul Birth?

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En caul birth, sometimes referred to as a veiled birth, occurs when a fetus is delivered still inside an intact amniotic sac. Abdominal or cesarean en caul births may be done intentionally using surgical techniques. A vaginal en caul delivery occurs spontaneously and is thought to be rarer.

This article discusses the process, complications, and risk of an en caul birth.

doctor with woman in labor

Ariel Skelley / Getty Images

How Common Is en Caul Birth?

En caul birth is very rare. By some estimates, it is believed en caul births would be 1% to 2% of all vaginal deliveries if there were no membranes that were artificially ruptured. This amounts to less than one in 80,000 births.

What Happens in an en Caul Birth?

During an en caul birth, the fetus remains inside the amniotic sac during labor and delivery, either vaginally or via cesarean section. Vaginal en caul births are the rarest form, as cesarean en caul deliveries may be undertaken intentionally by doctors using surgical techniques.

Is a Caul Birth the Same as an en Caul Birth?

An en caul birth is not the same as a caul birth. In a caul birth, a baby is born with part of the amniotic sac or membrane covering the head or face. This can give the appearance of a veil. The doctor or midwife can remove this. A caul birth is not as rare as an en caul birth.

A fetus born en caul is delivered still inside the amniotic sac. This may give the appearance the fetus is born in a clear, soft bubble that looks like a water balloon.

Once the fetus has been delivered, the doctor will usually immediately tear open the amniotic sac and retrieve the newborn. The baby will then be assessed.

What Normally Happens to the Amniotic Sac During Labor?

In most cases, the membranes that make up the amniotic sac rupture during labor or within 24 hours of labor beginning. This is often referred to as “water breaking.” This can occur spontaneously—referred to as spontaneous rupture of the membranes—and occurs most commonly once a person is in active labor.

In some cases, the membranes are ruptured by a doctor or midwife to speed up or start labor. This is referred to as an artificial rupture of the membranes.

In a regular birth, the amniotic sac ruptures and the fetus is delivered either vaginally or via cesarean section.

Benefits of en Caul Birth

In some cases, an en caul birth may provide protection for a fetus considered high risk.

The amniotic sac can provide a buffer for an unborn fetus and protect it from forces during labor and delivery. This may protect the fetus from bruising during contractions.

For a fetus that is extremely preterm, an en caul cesarean delivery may protect the fetus from pressure-related trauma during delivery.

Other benefits include protection from a cord prolapse—when the umbilical cord slips into the cervix in front of (or below) the fetus and can then be squeezed by the fetus. This is considered an emergency situation for a fetus.

An en caul vaginal delivery also decreases the risk of the fetus’s head becoming stuck in the event of the cervix not being sufficiently dilated.

En caul cesarean section may also be used in cesarean deliveries of low-birth-weight infants. One study from Japan suggests this is common practice among maternal and perinatal centers across that country.

Possible Complications of an en Caul Birth

The risks of a preterm en caul birth are similar to preterm births that occur not en caul. Possible complications following an en caul birth include:

  • Respiratory distress
  • Sepsis
  • Hemorrhage

An en caul cesarean section may also result in neonatal anemia.

Currently, there is a poor understanding of associations between en caul birth and neonatal survival time.

Risk Factors for an en Caul Birth

The risk factors of an en caul birth are poorly understood.

Most en caul births occur in premature births and when a person has had a low number of pregnancies.


En caul birth, sometimes referred to as a veiled birth, occurs when a fetus is delivered still inside an intact amniotic sac. This most often occurs during a cesarean birth.

Frequently Asked Questions

  • How rare is an en caul birth?

    An en caul birth—where the baby is born inside an intact amniotic sac—is extremely rare. An estimated 1 in 80,000 are born en caul.

  • What is a mermaid birth?

    A mermaid birth is another term for a baby born encased inside an intact amniotic sac. In a mermaid birth, also known as an en caul birth, the baby comes out of the womb in what looks like a bubble. The bubble is filled with amniotic fluid.

  • Can you have a vaginal en caul birth?

    Yes, but it is very rare that a full-term baby will be born en caul vaginally. En caul births are more likely to occur with premature and low-birth-weight babies.

  • Can you have an en caul birth if your water breaks?

    No, an en caul birth occurs when the baby is born inside of an intact amniotic sac. When your water breaks, it means the amniotic sac surrounding the fetus has ruptured.

    In some cases, the ruptured amniotic sac is still covering the baby when it is born. This is known as a caul birth.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. MedlinePlus. Premature rupture of membranes.

  3. Royal College of Obstetricians and Gynaecologists. Umbilical cord prolapse in late pregnancy.

  4. Takagi K, Muraoka M. Cesarean delivery “en caul” in Japan: results of a national survey of maternal and perinatal centers in JapanHypertens Res Pregnancy. 2019;7(2):56-61. doi:10.14390/jsshp.HRP2019-006

  5. Shibata T, Nakago S, Nishikawa S, Fukuoka Y, Iizuka N, Kotsuji F. A disadvantage of cesarean section en caul: umbilical velamentous insertion, a risk factor and proposed mechanism of neonatal anemia. J Obstet Gynaecol Res. 2020;46:173–175. doi:10.1111/jog.14147