|The first time I had an intact bag I was really scared because the head came out and there were eye/mouth/nose like 'divots' in the baby's face, but no openings! The face looked like moulded clay, not like a normal baby's face!
That happened to me as a student! Baby came out in the tight bag, rotated, and when I saw his "face" I thought, "Oh, God! He has NO FACE!" For about a second, all these thoughts went through my mind, like, "how am I going to tell his parents he has no face? how is he going to breathe?!" then I realized it was his BOW, and I slipped it over his head (he was making gasping motions) and he was born right away. I asked my preceptor if I looked shocked when the head was born, and thankfully, she said no, I looked fine, why? I told her what I was thinking and she howled
I've seen about 15 or more in the caul births, last month I saw three in a row! I love telling the mamas how special it is to be born in the caul...
Mostly, the BOW breaks either in transition, or pushing, and I have done AROM a handful of times. Quite often I can ask the lady nicely to "let your bag of waters go" and it will just release within a few contractions. I've only seen ROM before labour begins a handful of times.
That said, if the bag is taut and not bulging dramatically, most women don't feel any related discomfort, but when it's bulging, really
bulging, sometimes they ask to have it broken and feel quite relieved to be rid of the pressure. (I prefer to put a little leak in the bag instead of rupturing it, it's much gentler) If there's a lot
of fluid in front of the head, sometimes it keeps the baby from descending or that last bit of cervix from dilating and it's a big help to have it broken. Nothing like a hard little head to finish the job.
I do notice a tendency for in the caul births to be associated with a low-lying placenta and a Duncan presentation, and often get an exciting bleed after.