Fetus hand reaches out

Behind the camera: Michael Clancy
Where: Vanderbilt, Hospital Nashville
Photo Summary: Samuel Armas touching the surgeon’s hand while still being in his mother’s womb
Picture Taken: August 19, 1999

In late 1999, the closing days of the millennium, a story broke about a popular picture that was being emailed around the world. Matt Drudge a right-wing radio commentator who at the time had a show on FOX was actually prevented from airing the photo. The shot was of an operation with what appeared to by a baby’s arm reaching out of its mother’s womb and grabbing the surgeon’s finger. The picture was immediately seized upon by the anti-abortion establishment, which ensured that it would become an iconic picture.


Spina bifida is a disease were a baby developing inside its mother’s womb has a small lesion on its back exposing the spinal column. While the baby swims around the womb it hits the uterus walls and if the exposed spinal column hits the uterus walls the spinal nerves can be damaged. By the time the baby is brought to term irreversible damage is done. The results differ depending on the extent of the harm with some children being able to control their bowels and walk using crutches but others are forced to use wheelchairs, suffer from learning problems and endure endless operations to fix chronic life-threatening issues.

Enter the doctors

In 1992 two doctors, Dr. Joseph Bruner and Dr. Noel Tulipan met for lunch at Vanderbilt hospital. Tulipan treated many spina bifida patients but felt that the damage could be lessened if the lesion or opening that allowed the spinal damage could be closed as soon as it was detected. At the time, technology forced surgeons to wait until the baby was delivered before they could close the spinal column. Burner seeing the potential of a pre-birth operation suggested the two work together to perfect a surgical operation where they would operate on the fetus in the womb, “The idea,” Tulipan recalls, “was that we could prevent enough of the secondary injuries so that more spina bifida children would have a chance to walk.”

The two spent years practicing and perfecting the operation before settling on a procedure where they would remove the uterus, place it on the mother’s stomach, drain the amniotic fluid, operate on the fetus, refill the uterus, place it back in the mother and then allow the baby to continue full term. The operation soon had some success and word began to spread. Letters and emails starting pouring in. Some letters were from grown spina bifida patients who felt that the operation was playing god, risking the life of the fetus in order to create a “perfect” baby. However, most of the communication was from desperate parents willing to risk the surgery.

Not one but two

The pictures circling the Internet are actually of two babies undergoing the new Vanderbilt procedure. One picture is of Trish and Mike Switzer’s baby, Sarah Marie and the other popular shot is of the Armas’ baby, Samuel Armas. Both are being operated on by the two Vanderbilt surgeons Dr. Bruner and Dr. Tulipan.

Sarah Marie Switzer

The Switzer baby shot was taken by photographer Max Aguilera-Hellweg for LIFE magazine. During July 1, 1999, operation he captured the moment Dr. Bruner gently placed Sarah Marie’s hand back into the uterus. “She’s going to be beautiful,” he recalled saying.
Her parents would agree when on August 22, 1999, almost two months after having the surgery Sarah Marie Switzer was born. Born nine weeks premature, doctors were amazed at the health of the baby and allowed Sarah Marie to go home with her parents in early Sept. Sarah Marie showed none of the signs of extreme spina bifida and even kicked her legs as an infant rare in most spina bifida patients.

Sarah Marie Switzer in the womb

Sarah Marie Switzer's arm

Samuel Armas
Samuel Armas’ parents, Alex and Julie, discovered that Samuel had spina bifida during an ultrasound at 14 weeks. Doctors offered to terminate the pregnancy as the risks of delivering a healthy baby are rare. Julie refused to accept this solution and with her family scoured the net for information about the disease. It was then she came across the Vanderbilt procedure being performed by Bruner and Tulipan. She quickly raised the money, as an experimental procedure American insurance companies refuse to pay for the operation, and performed the surgery during the 21st week of surgery.

The Armas’s family also allowed the operation to be photographed and let Nashville free-lance photographer Michael Clancy take pictures of the Aug. 19, 1999 operation, the 54th mother to undergo the procedure. Clancy’s picture eventually was published as part of a September 7, 1999, article in USA TODAY. From there other media picked it up and it quickly spread around the world.

This photo has become an icon … Depending on your political point of view, this is either Samuel Armas reaching out of the uterus and touching the finger of a fellow human, or it’s me pulling his hand out of the uterus … which is what I did. … The baby did not reach out the baby was anesthetized. The baby was not aware of what was going on.
Both mother and fetus were drugged and would not have been able to move on their own and according to Dr. Tulipan, who closed the hole in Samuel’s spine, at 21 weeks Samuel, “would have no ability to reach out and grab anything,”

Clancy the photographer offers a different version where he claims that little Samuel “thrust” his arm out of the uterus incision and Clancy took a picture when the surgeon, “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.” The medical journal write up of the operation offers this version of events:

[J]ust 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.
Whatever happened, a healthy Samuel was born on December 2, 1999, and almost four years later, on September 25, 2003, Alex and Julie Armas testified before the U.S. Senate Subcommittee on Science, Technology, and Space about the photo and their experience with the surgery. Samuel was also present and his father said, “Today, Samuel is nearly four years old and has not had to endure the surgeries that are common for most children with spina bifida. He’s walking with leg braces, is cognitively normal, and loves looking for bugs.”

The Drudge Connection

In Nov 1999 the right-wing news gossip guru, Matt Drudge, had a Saturday night television show called Drudge on the Fox News Channel. Drudge wanted to show Samuel’s image on his Nov 13 show but Fox news directors refused to allow Matt to display the image. He refused to go back on air crying censorship and the two parties supposedly, “amicably”, went their separate ways with the November 6, 1999 episode of Drudge being the last.

Fox News directors refused to allow the airing of the picture because they feared that Drudge, a staunch anti-abortionist, would use the picture to further his argument against late-term abortions. The news directors felt that this use would miss-represent a picture that they felt represented a breakthrough medical procedure for spina bifida NOT a picture to be used for or against abortion.

Buy it to Kill it

When Michael Clancy took the picture of little Samuel he had no idea that he was going to get in a life-altering experience and at the same time battle LIFE. In fact, when he initially took the picture he didn’t even know if the shot was in focus. To prevent digital manipulation of images USA Today requires that all film be submitted unprocessed. So he had to wait until 10 days after he submitted the film before he finally heard that the photos turned out alright. USA Today loved the shots and the photo editor called saying, “It’s the most incredible picture I’ve ever seen.” They were published on September 7th, 1999 in USA Today and The Tennessean Newspaper with Clancy’s caption, that Samuel reached out on his own.

When Clancy’s picture was released he didn’t realize it but he was scoping, at the time, one of the biggest magazines in the world, LIFE magazine. They had Max Aguilera-Hellweg take the Switzer baby shot and were planning to do a big story called “Born Twice” in their December 1999 issue. Their photo was posed and as Clancy asserted his picture wasn’t, the baby reached out on its own. Also, the Switzer baby operation was taken at 24 weeks into the pregnancy, while the shot of Samuel was taken at the 21-week mark.

Clancy offered to sell the picture to LIFE and initially, they agreed. Clancy’s agent told him over the phone, “They do want to buy your picture. They want to buy it to kill it.” The photojournalist quickly told him no way and that if LIFE didn’t buy it to print then he would spread the shots through multiple media outlets and thus kill the LIFE magazine big breaking news item as by then the story would be old news. After negotiations that went on over four days LIFE eventually decided to pass on the photo and true to his word Clancy aggressively published his photo so by the time December rolled around LIFE had buried their story and picture in the back of their Dec issue.

Mike Clancy thought he had won his little battle but then a bomb dropped. Dr. Bruner, whose hands which are present in both shots, released a statement where he stated, “The baby did not reach out, The baby was anesthetized. The baby was not aware of what was going on.” This directly contradicted what Mike Clancy stated and published in his caption where he claimed that Samuel reached out on his own. The doctor’s statement in Clancy’s opinion “stripped any credibility” that he had as a journalist. His Editors and co-workers were soon asking why he lied about the picture but Clancy stuck to his guns always claiming that Samuel reached out and grasped Dr. Bruner’s hand. Even though the photographer was eventually forced to leave his profession as a result of the caption discrepancy he doesn’t blame Bruner stating, “He’s an incredible surgeon but [he] simply could not admit the unborn child came out from under the anesthesia too soon.”


Dr. Bruner, while acknowledging that his experimental surgery is still in the early development stages and poses significant risks, he looks to a future where this surgery will be performed across the world, offering incredible promises to parents of unborn children with birth defects.

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