Michelle Duggar, star of the TLC reality TV show "18 Kids and Counting," astounded America last week with the announcement of the birth of her 19th child -- Josie Brooklyn Duggar.
For now all eyes are on "micro-preemie" Josie Brooklyn in the neonatal intensive care unit, but doctors point out that the Duggar family tradition of back-to-back pregnancies may be slowly adding to the health risks for Michelle and future Duggars.
"I am not aware of this couple's reasoning on the matter of contraception," said Dr. John B. Coppes of the Austin Medical Center-Mayo Health System in Austin, Minn. "However, I hope they are aware of the risks for Down syndrome, uterine rupture, future C-sections, pre-eclampsia."
TLC continues to report that mother and baby are doing fine at the University of Arkansas for Medical Sciences in Little Rock.
All pregnancy carries risk, but some doctors say any woman, even with Duggar's stamina, increases her chances for health problems with numerous pregnancies.
Dr. Katharine Wenstrom, director of Maternal Fetal Medicine at Vanderbilt Children's Hospital in Nashville, Tenn., rattled off a list of complications, including life-threatening bleeding during birth, risk of heart attack or stroke -- all exacerbated by multiple pregnancies.
"She has an increased risk of uterine atony, or failure, of the uterus to contract after delivery, which can cause life-threatening blood loss and may require hysterectomy," said Wenstrom, who added that women who have multiple pregnancies are at risk for a condition called placenta previa. In such cases, she said, "the placenta implants over the cervix -- also associated with life threatening bleeding."
Although it seems only time is limiting the number of children that families like the Duggars can have, doctors say each pregnancy actually scars the walls of the womb, leaving limited real estate for a new pregnancy.
"Every time you have a pregnancy, the placenta implants in the uterus and that implantation site cannot be used again because it's scarred," said Dr. Diane Harper of the University of Missouri in Kansas City.
The more children you have, the more likely the placenta will implant in an inopportune place such as over the cervix (placenta previa). "You run the risk of developing problems with the placenta attachment," Harper said.
Going through 19 labors also stretches the mother's pelvic muscles and ligaments, sometimes to the point of causing uncomfortable or embarrassing problems.
Moms who've had multiple pregnancies usually have short labors and they're usually able to push the baby out with relatively little effort, according to Harper. But the elasticity of their pelvic floor can cause other problems.
If a baby starts to come prematurely, doctors have greater difficulty keeping the woman from delivering, Harper said. If the muscles around the uterus are sufficiently weakened, the result may be a condition called uterine prolapse, in which the uterus drops partway into the vagina.
The weakened muscles can also leave a woman incontinent, Harper said.
"The abdominal wall will lose all tone, causing intestinal hernias as well as putting intestines at risk for volvulus [a bowel twisted in a loop]," said Harper.