This story happened in July 1999. Baby Samuel had been diagnosed as having spina bifida, and pioneering corrective surgery was perfomed by surgeon Dr Joseph Bruner in Nashville, USA. During the surgery, at 21 weeks into the pregnancy, Samuel's tiny hand came out from the womb and grasped the surgeon's finger. Freelance photographer Michael Clancy was present during the operation and captured this remarkable moment on film.

At The Children's Project we continually try to show and explain just how remarkable the abilities newborn babies are. For us, this picture clearly demonstrates that some of these abilities are in place long before birth.

The event sparked a wide debate around the world - as a search under Samuel Armas will reveal. There are many sites reporting the event and discussing the pro's and con's of the high risk procedure. On the right are some links to organisations with information and support for spina bifida patients.

The procedure (called maternal-fetal surgery for spina bifida) is rare, and can be available now as part of a prospective, randomized trial sponsored by the NICHD in the USA. More information can be found at spinabifidamoms.com. For more information about fetal surgery, fetal-surgery.com.

Photographer Michael Clancy's own story
As a veteran photojournalist in Nashville, Tennessee, I was hired by USA Today newspaper to photograph a spina bifida corrective surgical procedure. It was to be performed on a twenty-one week old fetus in utero at Vanderbilt University Medical Center. At that time, in 1999, twenty-one weeks in utero was the earliest that the surgical team would consider for surgery. The worst possible outcome would be that the surgery would cause premature delivery, and no child born earlier than twenty-three weeks had survived.

The tension could be felt in the operating room as the surgery began. A typical C-section incision was made to access the uterus, which was then lifted out and laid at the junction of the mother's thighs. The entire procedure would take place within the uterus, and no part of the child was to breach the surgical opening. During the procedure, the position of the fetus was adjusted by gently manipulating the outside of the uterus. The entire surgical procedure on the child was completed in 1 hour and thirteen minutes. When it was over, the surgical team breathed a sigh of relief, as did I.

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.

The surgical opening to the uterus was closed and the uterus was then put back into the mother and the C-section opening was closed.

It was ten days before I knew if the picture was even in focus. To ensure no digital manipulation of images before they see them, USA Today requires that film be submitted unprocessed. When the photo editor finally phoned me he said, "It's the most incredible picture I've ever seen."

Click on image to see an enlargement.

Just twenty-one weeks in utero, and following surgery, baby Samuel grasps the surgeon's finger.

This picture is copyright © Michael Clancy 1999. For permission to use or to order a print, click here.

Links
ASBAH (UK)
SBAA (USA)
Children with Spina Bifida (Worldwide organisations and support)