It's a philosophy to which the Duggars, devout conservative Christians, subscribe. But one's belief in God should not minimize other important issues involved in families so large, medical and environmental experts say.
In addition to the hemorrhage risk, Cain, the chief OB-GYN at Women & Infants hospital in Providence, said women such as Duggar, after their child-bearing years, are also at greater risk of incontinence and even uterine prolapse, in which the uterus falls to the pelvic floor.
"This woman is lucky that she exists in a society where if she has any of those complications, we have ways of dealing with them," Cain said. "Yes, women used to have that many children. But many mothers didn't survive, and their children died at an earlier age. We forget that."
Dr. Amy Sarver, Duggar's OB-GYN, told People magazine after she delivered Duggar's 18th baby, "Some women are made to have babies, and Michelle is to the nth-degree."
Alan Weisman, the author of "The World Without Us," raises another concern, about the Duggar family's impact on the environment. Each child, he said, multiplies his mother's carbon legacy by 5.7 percent, which means the Duggar children alone could be responsible for contributing more than a million metric tons of carbon dioxide to the atmosphere.
"Big families have always been portrayed as something lovable and beautiful," Weisman said. "Think of 'The Waltons.' But we do have an issue now, where it's not just about home and family. It's about the planet, and the planet hasn't gotten any bigger. We only have one atmosphere."