The Weirdest Cry For Help Imaginable: Vagitus Uterinus

A baby’s first cry has always been a symbol of celebration and an assurance of good health, there’s a word for it: vagitus. Some babies may take a bit longer than others to start crying after birth but what about those who can’t even wait to get out of the uterus to start crying? 

This article will discuss difficult labours and stillbirth.

Small World

I was reading my new old book by Anne Geddes, Small World: A History of Baby Care from the Stone Age to the Spock Age (published in 1963) when I came across this entry:

“Not all babies are born conformists, however. Two were born in the twentieth century– one in Cincinnati, Ohio, in 1947 and one in England in 1957– who practised vocalizing before they were born. The doctors could hardly believe their ears, but they heard crying coming from inside the womb.”

pg 33

My response was…. “bullsh*t.”

Of course I googled it… and… well, I was a bit presumptuous. (I’m sorry Ms Geddes.) There are scores of case reports from respected medical journals and sections about the phenomena in obstetrical textbooks.

[now, Dear Reader, cue that wavey time travel effect in your mind’s eye]

Dr Watson, 1932

It was shortly after midnight on October 25, 1932, when Dr Robert Watson was called to assist at a birth. The mother was 32 years old and in labour with her seventh child. She was fully dilated and effaced, the baby presenting as a frank breech. Her contractions were strong but the baby was still “above the rim”. Dr Watson gave the mother chloroform and pulled down one of the fetal legs by the foot. After turning to get something,

“My back was towards the bed when I heard just such a muffled cry as comes from the newborn infant in a blanket. I whipped round, the nurse looked startled; we both bent over the anaesthetized woman and heard noises, unmistakable, familiar, from the woman’s abdomen. […] They were simple baby noises, natural in tone, not urgent, suggesting no distress.”

Robert Watson, 1933. BMJ.

However, recognizing the danger to the baby, the nurse and doctor worked very quickly to pull the baby out– a chonk of a boy, 11 lbs and 12 ½ oz (5.3 kg)– breathing well. Dr Watson tried to account for how the baby could have audibly cried before it was born, with its face at the top of the uterus. He theorized that air got into the uterus when he was reaching in to manipulate the baby’s leg and the baby, already having difficulties in birth, took its first breath and cried while still in the womb.

 It was a case of vagitus uterinus

Time is of the Essence

… or is it?

Today we know from imaging studies that the fetus reflexively “practices” limb movements and facial expressions– and crying– in the womb. But because there isn’t any air moving across fetal vocal cords, due to the amniotic fluid (at least until the waters break), there is no audible sound to the crying. 

Immediately after birth, whether vaginal or c-section, the exposure of the baby’s body to room air triggers a reflex to take a breath and cry, this cry is called vagitus (named after the Roman god Vagitanus who teaches newborns to cry). It helps clear and expand the lungs but this is an over-simplification, in a paper on the transition from intrauterine to extrauterine life the authors said:

“The transition from a fetus to a newborn is the most complex physiologic adaptation that occurs in human experience.”

(Hillman et al 2012

explaining that the process involves all organ systems including the skin, the endocrine system, and the hypothalamus– and once this process begins, it’s not supposed to reverse itself.

During pregnancy, the fetus receives oxygen and nutrients, and expels carbon dioxide and waste products, through the placenta (via the umbilical cord) which is tapped into the maternal blood supply. If something happens to the placenta or the umbilical cord it can cause the baby to asphyxiate if it cannot breathe on its own due to immaturity or its environment (i.e. still in the womb with or without amniotic fluid). In short, if a baby isn’t born yet and needs to or is triggered to breathe, they are unlikely to survive unless they can be delivered immediately

For example, in 1924, C.S. Morton of Halifax, attempted a vaginal examination causing the as yet unborn baby to cry out. Even though the doctor worked quickly to deliver the baby, it took too long and the baby suffocated.

Dr Clouston, 1931

The risk of suffocation resulting in a stillbirth was what Dr Clouston understood when on Nov 10th, 1931 he was called to a stalled labour by the district nurse around 8:30 a.m. His patient had gone into labour the previous night around 10 p.m. and was having her third baby (the previous two births had been uncomplicated). She was fully effaced and dilated but she wasn’t having contractions and the baby was engaged in a brow presentation. Brow presentation occurs in around 1:2000 births and is associated with back labour and nuchal cords (when the umbilicus wraps around the neck).

Dr Clouston wanted to move the baby’s head into a face presentation but it wouldn’t budge, then

“As I was withdrawing my hands after the vaginal examination the child began to cry. It was the normal crying of a newly born infant, and was heard by not only the mother, the nurse, and myself, but also a woman in the cottage room directly below the bedroom.”

Dr ECT Clouston, 1933. BMJ.

He noted that the crying continued at frequent intervals for a minute. In a hurry, he told the nurse to administer chloroform so that he could use forceps to deliver the baby asap. But the nurse couldn’t or wouldn’t put the mother completely under and the baby wasn’t budging… it also hadn’t cried again.

Dr Clouston eventually called it: the baby had suffocated before birth. There was no more need to rush and so he called for his wife, who was better qualified to administer chloroform. While they waited for her to arrive, the doctor did another examination and was shocked to hear a fetal heartbeat. Twins? He palpitated the abdomen but could only make out one fetal body.

Smellie, W. 1787. Wellcome Collection.

When his wife arrived, the mother was having moderate contractions again and was put completely under while Dr Clouston attempted to remove the baby. This time he was able to get his hands around the fetal head to reposition it, his finger slipped into its mouth and the baby bit down. Dr Clouston rushed to get his forceps and delivered the baby at 1 p.m., alive, four hours after they had heard its cries. 

Dr. A Fraser, 1904

The experiences of many doctors who witnessed VU only to deliver living babies hours later did cause some curiosity about whether fetuses could alternate between pulmonary respiration (breathing room air) and placental blood oxygenation.

On Feb 2nd, 1904, Dr A Fraser was called to a delivery of a 25-year-old first-time mother by the local nurse. The patient had come to the nurse’s attention after having been in labour a full week under the care of a (Dr Fraser added scare quotes:) “a lay midwife”. The nurse did not know when the patient’s water had broken, as it was broken before she arrived. Dr Fraser noted that the patient looked healthy but was exhausted and in considerable pain with a pulse of 116 bpm. The OS (her cervical opening) was only dilated to the size of a “5 shilling piece” (1.5 in/ 3.8 cm) and uneffaced. (I imagine the examinations were excruciating for her and there is no note of chloroform being used.)

Dr Fraser agreed with the nurse’s diagnosis of brow presentation and so attempted to move the fetal head, but it didn’t work, so he had the mother change position and then it happened:

“after she assumed this posture a series of plaintive cries were heard to come from the vagina. The patient herself heard them and recognized their source, and they could be heard at the other side of the room.” 

Dr A. Fraser, 1905, Glasgow Medical Journal.

Dr Fraser reported the options for getting the baby out asap that flooded his brain at that moment; he decided on the least injurious to the mother because he didn’t believe that the baby could be born alive even with surgical interventions because of the prep time involved. He went with version, reaching into the uterus and grabbing a fetal foot and pulling. He used traction while the nurse pressed on the mother’s abdomen. It took ninety minutes of work to get the baby out, most of which time, the baby’s body was completely blocking any air entering the womb. The baby was born cyanosed (blue)- but it gasped- it was alive! The doctor and the nurse gave the baby artificial ventilation for “some time” and then gave an injection of 1/60 of a grain of strychnine, which they credited with helping breathing become regular.

The issue that nagged at Dr Fraser: how did the baby survive without breathing for over an hour after it had clearly begun breathing in order to cry? He wrote,

“the prognosis ultimately depends upon the ability of the child’s left ventricle to maintain the placental circulation during that part of the delivery when pulmonary respiration is not possible. […] it is possible that in some of the cases the circulation may revert to the fetal type after the cessation of the cries.” 

ibid

C-Sections

If I had heard my baby crying in the womb and my midwife or doctor failed to suggest it within seconds, I would probably be screaming down the place for a c-section. However, in multiple historical cases of vagitus uterinus, the doctor felt that there wasn’t enough time for a c-section, just like Dr A Fraser.

Dr Ryder, 1923 No Time!

Dr Ryder made a similar choice in 1923 after hearing a fetus crying and gurgling in the uterus. He had promised his patient (whose first child suffered Erb’s Palsy after a difficult assisted delivery and her second child was killed by misapplied forceps) that if her labour was difficult this time they would opt for a c-section, and that’s what they were about to do when:

“With a stethoscope on the patient’s abdomen, immediately most amazing sounds were heard. Very plainly the fetus could be heard crying loudly. The sounds were high and squeaking, much like the mew of a kitten. When the crying stopped, the fetus could be heard breathing with gurgling respirations, as though choking with fluid. Both assistant and nurses listened and heard plainly the crying and breathing.”

“It seemed probable that the fetus would inspire too much liquor amnii, in spite of the ruptured membranes, and it was considered unwise to wait for the section. So the patient was replaced in the lithotomy position, the ether was resumed, and by internal podalic version the presentation was changed to breech. The breech extraction was performed slowly and carefully and resulted in the birth of an undamaged baby which was soon revived and crying lustily.”

George Ryder, 1943, Amer J Obstet.

Dr Smith, 1905 No Rush…

But not all medical professionals seemed to take the need for speed seriously. In an earlier case report in the British Medical Journal from Feb 4th 1905, Dr Temple Smith and his colleague had been called to the delivery of a 40-year-old experienced mother, who was dilated and having strong regular contractions for “some time” but the fetal head wasn’t “below the brim”. They gave her chloroform and proceeded to manually examine the position of the fetus and found the issue: its arm was stuck up behind its head, and it had no intention of allowing them to move it, so they decided to do a version, which means spinning the entire fetus around to force a breech birth (a common intervention at the time.)

Jewett, Charles. 1901. “The Practice of Obstetric” p712. archive.org

As Dr Smith reached for the fetal knee everyone (Dr Smith, his colleague and the attending nurse) heard it: the fetus cried. But they simply continued their work, getting together a tape to tie around the fetal ankle, the application of which caused the fetus to cry out again, this time they noted the time: 8:30 a.m.

Unlike other doctors, Dr Smith and company were in no rush… they had spun the baby round and waited for the contractions to do the rest. Three hours later the baby was born, with a small amount of traction on the breech due to its large size. They noted that it was born “somewhat asphyxiated” but the “normal measures” got it breathing and a year later the baby was a normal thriving toddler.

Dr Joseph B De Lee, 1928 Textbook

In the 1928 textbook Principles and Practice of Obstetrics by Dr Joseph B De Lee, professor of obstetrics at Northwestern University, he said of vagitus uterinus: 

“This term has been applied to the crying of the child in utero– before it is born. Many authentic cases are on record.[…] If air is introduced into the uterine cavity alongside the hand, as in version, or with instruments, or by a simple examination, or if gases develop there, the child may inspire, and, on expiration, produce a cry. Sometimes this may occur without evidence of dyspnea, and the child may be delivered in good condition, sometimes hours or days afterwards.” 

I was pretty shocked about “days afterwards” and only to read another article from 1951, in the British Medical Journal, they claim that in Ryder’s 1943 study, the longest interval between VU and live birth was two weeks— but more on that two-week outlier in a bit.

Prognosis

These contradictory case reports and descriptions are confusing: vagitus uterinus is (except in the one case) considered a medical emergency yet babies are born alive hours, days, or even weeks later? What was the medical consensus? Was there one?

Dr Peiser 1903 vs Dr Marx

In 1903, Dr Peiser reported on fifteen cases of VU, including his own experience, in which the baby cried while he was, and I quote, “exploring” during a vaginal exam. He gave the mother chloroform so he could do another vaginal exam (I don’t trust this guy) and the baby cried again. After a quick delivery via forceps, he concluded that the vagitus uterinus was “by no means unfavourable to the fetus”.

But his contemporary, Dr Marx, from America, disagreed, he had had an experience with vagitus uterinus himself during a forceps delivery, describing the crying as “the weirdest cry for help imaginable” and determined that most if not all the children who exhibit it are lost before they can be delivered.

Dr Telfair, 1913

In October of 1913, Dr Telfair published a report in the New York Medical Journal: he complied 44 cases of VU, over half were operative cases: 11 forceps, 15 versions, and one involved moving the fetal limbs and cord. Based on his analysis, the fetal mortality was only 10% but the survivors often required extensive resuscitation. Later analysis by George Ryder in 1943 showed historical mortality rates of 19% with recent (to his time) mortality of around 12%. (If you have access to academic journals and would like to help me out– if you could send me a copy of Ryder’s original article, that would be super swell.)

Criticism

In the first decades of the 20th century, there were so many case reports flooding into medical journals across Europe and North America that it seemed like VU was an accepted, though rare and risky, occurrence by the medical community.

But there was pushback. 

In Dr Telfair’s 1913 report he noted that the case reports of vagitus uterinus

“had aroused a storm of criticism, sometimes ridicule […] the bitterest usually came from obstetricians of wide experience. These men frankly said that they had never seen a case [of vagitus uterinus], and they did not believe anyone else had.” 

Dr ECT Clouston, 1933. BMJ.

Dr Sippel’s Queef

Dr Sippel, a VU skeptic, had a case in which he heard noise from the vagina during an examination, but his theory was that it was the vibration of a “fold of mucus membrane” as the air was sucked into or out of the uterus, Clouston’s article summarized his theory:

“There seems usually to be a flabby uterus on the one hand and an obstetrical operator admitting air into its cavity on the other.”

ibid

In other words, Dr Sippel rejects all claims of vagitus uterinus as queefs mistaken for a baby’s cries. That’s one classy dude.

US Military, 1947 VU Affidavits

In 1947, the US Army was so bamboozled by these epic queefs as to publish case reports on two cases. Out of 499 births that took place at the AAF Regional Station Hospital in Mitchel Field New York in 1945, two involved vagitus uterinus. In one case, which took place on January 26th, the 31-year-old first-time mum was given an epidural, and when the doctor applied the forceps

“the fetus made several cries which were audible to five individuals including the patient, who inquired whether her child was a boy or a girl.”

GA Bourgeois and HL King, 1947, Bull US Army Med Dep.

It took another seven contractions with the forceps before the baby (a boy, 6 lb 8oz/ 2.9 kg) was born at 5:21 p.m. The witnesses to the VU signed affidavits. Mother and baby left the hospital after an uneventful postpartum stay of NINE DAYS.

“True” Vagitus Uterinus

Dr Fraser, 1864

But there were some cases described that were clearly not vagitus uterinus. Another Dr Fraser gave a presentation on July 27, 1864, before the Obstetrical Society of Edinburgh about a case of what he considered true vagitus uterinus,

“By the term vagitus uterinus I suppose is meant not the crying of the child after rupture of the membranes when the external air can reach it, virtually a phrase of extra-uterine life, but the crying of the foetus in utero while the ovum is entire.”

Dr Fraser, July 27, 1864.

To translate: Dr Fraser believes that only vagitus heard before the water breaks is true vagitus uterinus, otherwise it’s just sparkling queef.

What he suggests is not possible because the vocal cords cannot make sound without air. But he believed that one of his patients experienced this not just once but during two pregnancies. The first occurrence was during her first pregnancy, about 10-12 days before the due date. She was lying in bed trying to relax, her unborn baby doing the fetal equivalent of parkour, while her husband read from the bible next to her.

“All at once they heard with amazement a cry like that of a newborn babe. Though somewhat muffled, the sound was yet so distinct and so evidently arose from the place beside him that Mr. G could not help exclaiming: ‘Mercy on us, is the child in the world?’”

Mrs G was certain that

  1. She had not given birth and
  2. That sound was definitely from their unborn baby and nowhere else.

They were both overcome with emotion, it was their first baby’s first cry!

(uh-huh)

The birth, when it finally took place, two weeks later (this is where I think Ryder got that VU to live birth interval) was normal: a healthy boy. Over the next few years, she had two more babies, with no “vagitus uterinus” of any definition. But in her fourth pregnancy, in a very similar situation to the first, about a week before she was due while relaxing on the couch after the children were gone to bed- this baby also doing parkour off her internal organs- her husband was sitting around ten feet away reading,

“when she heard a sound like the bleating cry of a newborn baby, which seemed to come from her womb, and which she is positive did come from that part. Her husband also heard it where he was sitting, and so distinctly, that, dropping his book, he started to his feet and thought for a moment that the child was really born.”

They didn’t hear the sound again, she had a normal birth, a baby girl. Followed by two more quiet pregnancies. 

I’m sure many of you already have a theory about what the sound was and from whence it came… but the lovely dears at the Obstetrical Society of Edinburgh, bless them, had follow-up questions: 

“Both instances occurred when mother was at rest. Is quietness on her part necessary to the production of the sound? Is it not likely that instances pass unnoticed during sleep? Whence the air which enables the foetus to cry? Is it excreted by child itself or by the membranes?” 

When this presentation was published in the Edinburgh Medical Journal in November 1864, the editor added a note:

“If it be admitted that a child can cry in utero, it must also be admitted that the lungs can be more or less expanded before birth, though the child be afterwards born dead; hence another reason for caution in judging from the hydrostatic test.”

This last question gets into Scotland’s draconian laws on concealed pregnancy, abortion, and feticide but I only include it to show the apparent credulity of these medical professionals. However, when it was republished by the Americans, they addressed the gassy elephant in the room:

“We are induced to ask another question: Was not the sound produced by the movement of air in the bowels?” 

(Honestly, the most amazing part of this case report is that Mr G was a reading man.)

Portents and Superstition

Dr Matthaisson, 1909

In April of 1933, Dr Matthaisson wrote into the British Medical Journal about his own experience in November 1909 when he was attending a birth assisted by a midwife and a nurse who both heard the cries of the fetus which he described

“It sounded pitiful, and was much like the crying of a newborn child hidden under a duvet (an eiderdown).”

Heingrimur Matthaisson, 1933, BMJ

And he added that while Iceland’s and Denmark’s medical communities more or less ignored his case reports, after publishing them in a lay newspaper he received many letters describing vagitus uterinus experiences, especially from farmers who said they had heard in cows during prolonged labours. And an elderly woman told him that the phenomenon was described in dogs in the Icelandic sagas as a portent of great events, “the whelps barked within the womb of the bitches”.

Dr McLane, 1898

Dr Malcolm McLane reported that in 1898, while he and his colleagues and nurses were prepping a patient for a c-section, in an operating theatre. He performed a vaginal examination to make sure the baby’s head was still in the uterus and as he withdrew his hand or arm there was some suction and, he

“was astounded to hear the baby cry”

which continued for several minutes, and which everyone heard, and

“There was a superstitious nurse present, who spent much of her time on her knees.” 

Witchcraft?

In Geddes’, Small World, she noted that,

“In the past they would probably not have dared to admit what they heard because the rare occurrence of vagitus uterinus[…] was believed to be caused by midwifely witchcraft.”

I tried to find more examples of superstitions around the phenomena, including “midwifely witchcraft” but I wasn’t successful. It’s possible that VU was so rare and prior to modern obstetrics and neonatal resuscitation, few of the babies involved survived for mythology to build upon. But if you know of any myths or legends about it, please share in the comments.

Further Research

There are a few case reports and studies that I found but couldn’t access due to paywalls from the second half of the 20th century and one in particular from 1973 where the fetuses involved were under heart monitoring when the vagitus uterinus occurred. Let me know if you would be interested in learning more about this issue!


Do you have any stories about or experience with vagitus uterinus? Please share in the comments or send me an email. If you enjoyed this post please subscribe so you don’t miss future posts. And if you would like to support my research, consider becoming a patron on Patreon.

Sources

Articles I couldn’t access but want to read:

  • Thiery M, M Vrijens, D Janssens. Feb 1973. “Vagitus Uterinus.J Obstet Gynaecol Br Commonw, 80(2), p183-
  • Ryder, George H. Dec 1943. “Vagitus Uterinus.” American Journal of Obstetrics and Gynecology, 46(6), p867-872.
    • Short Rant: this is a nearly 80-year-old article of taxpayer-funded research that is lodged firmly behind a paywall of a private corporation. I can’t email the author to ask for a copy because they’re dead. I cannot even access it through my alma mater’s library as a community borrower. If I request it from my local public library they will spend more taxpayer dollars to retrieve a copy. Elsevier is an absolute racket.

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