Caul birth: A retrospective cohort study on prevalence,predictors, and maternal and neonatal outcomes

INTRODUCTION: Caul birth, in which an infant is born with part of the amniotic sac covering the head or body, is a rare phenomenon with limited research on its prevalence, predictors, and outcomes in contemporary midwifery and obstetric practice. Although it has historically been attributed cultural and symbolic significance, it remains underexplored in research. The aim of this retrospective cohort study was to investigate the prevalence of caul birth, its predictors, and associated neonatal and maternal outcomes in a Swedish hospital setting. METHODS: A retrospective cohort study including all births at a Swedish hospital in 2023 (n=1382) was conducted. Data were obtained from medical records. Women with caul birth were compared with those undergoing amniotomy during labor (n=377). Multivariable logistic regression was used to identify predictors and maternal and neonatal outcomes associated with caul birth. RESULTS: Caul birth occurred in 1.5% (n=21) of births and was associated with maternal overweight according to BMI (AOR=3.42; 95% CI: 1.10-10.64), spontaneous onset of labor (AOR=18.21; 95% CI: 2.31-143.50), and multiparity (AOR=11.11; 95% CI: 1.34-92.10). Epidural analgesia (AOR=0.10; 95% CI: 0.02-0.44) and longer duration from hospital admission to birth (AOR=0.63; 95% CI: 0.48-0.84) were associated with decreased odds of caul birth. No adverse neonatal outcomes were observed. CONCLUSIONS: Caul birth was rare but associated with spontaneous, low-intervention labor and reassuring maternal and neonatal outcomes. These findings align with current recommendations against routine amniotomy in uncomplicated labor, although larger studies are needed.