Born Twice

An experimental – and controversial – procedure for treating a crippling birth defect in the womb offered Trish and Mike Switzer the only chance that their daughter would walk like other children. But the fetal surgery posed a fatal dilemma: Their baby could die before she was born.

Photographer Max Aguilera said about this photo: “During a spina bifida corrective procedure at twenty-one weeks in utero, Samuel thrusts his tiny hand out of the surgical opening of his mother’s uterus. As the doctor lifts his hand, Samuel reacts to the touch and squeezes the doctor’s finger. As if testing for strength, the doctor shakes the tiny fist. Samuel held firm. At that moment, I took this 'Fetal Hand Grasp' photo. As a photojournalist, my job is to tell stories through pictures. The experience of taking this photograph has had a profound effect on me, and I’m proud to share this moment with you”

The image accompanying the text quoted above is real in the sense that it is indeed a photograph taken during a revolutionary fetal procedure undertaken on 19 August 1999 to fix the spina bifida lesion of a 21-week-old fetus in the womb. The operation was performed by a surgical team at Vanderbilt University in Nashville which developed a technique for correcting fetal problems in mid-pregnancy by temporarily removing the uterus, draining the amniotic fluid, performing surgery on the tiny fetus, then restoring the uterus back inside the mother. The patient shown above, Samuel Armas, was the 54th fetus operated on by the surgical team; Dr. Joseph Bruner, the surgeon whose hands are pictured above, alleviated the effects of the opening in Samuel's spine caused by the spina bifida, a congenital disease that often leads to paralysis and other problems. Pictures from the surgery were printed in a number of newspapers in the U.S. and around the world, including USA Today, and thanks to the remarkable surgical procedure performed by the Nashville team little Samuel was born healthy on 2 December 1999.

However, it is not true, as described in the accompanying text, that these photographs were taken as Samuel's hand "emerged from the mother's uterus to grasp the finger of Dr. Joseph Bruner as if thanking the doctor for the gift of life," or that Dr. Bruner said "when his finger was grasped, it was the most emotional moment of his life." This misinformation has been propagated by many different sources, including the Michael Clancy, the photographer who snapped the pictures: "As a doctor asked me what speed of film I was using, out of the corner of my eye I saw the uterus shake, but no one's hands were near it. It was shaking from within. Suddenly, an entire arm thrust out of the opening, then pulled back until just a little hand was showing. The doctor reached over and lifted the hand, which reacted and squeezed the doctor's finger. As if testing for strength, the doctor shook the tiny fist. Samuel held firm. I took the picture! Wow! It happened so fast that the nurse standing next to me asked, 'What happened'?" "The child reached out," I said. "Oh. They do that all the time," she responded.

What actually took place, as described in news reports of the surgery, was that: Just as surgeon Dr. Joseph Bruner was closing the incision in Julie Armas' uterus, Samuel's thumbnail-sized hand flopped out. Bruner lifted it gently and tucked it back in.

(The dubious veracity of the photographer's version of events is highlighted by the disclaimer he appended to it on his web site, stating that it represented his "opinion of the events as they took place during the surgery for Samuel.")

The surgeon, Dr. Bruner, later elaborated on some of the exaggerated and false claims made about the photograph:
"It has become an urban legend," says Bruner, the Vanderbilt University surgeon who fixed the spina bifida lesion on Samuel. Many people he hears from wonder whether it's a fake.

"One person said the photo had been reviewed by a team of medical experts and they had determined that it was a hoax," Bruner says with a laugh.

More commonly, people want to know how the photo came to be. Some opponents of abortion have claimed that the baby reached through the womb and grabbed the doctor's hand. Not true, Bruner says. Samuel and his mother, Julie, were under anesthesia and could not move. "The baby did not reach out," Bruner says. "The baby was anesthetized. The baby was not aware of what was going on.