Dec. 16, 2009 -- The Duggar family's 19th child, Josie Brooklyn, who was born nearly three months premature weighing less than 2 pounds, is giving her famous family something to smile about these days: She's taking breast milk.
Freda Ruark, sister of mom Michelle Duggar, said that after three breast milk feedings, Josie Brooklyn was able to keep down two.
"The baby is doing great," said Ruark, who has spoken to her sister and her sister's husband, Jim Bob, every day since her niece was born.
"Josie is holding her own. As long as she can get some of that breast milk, that will help build up her immune system."
Jim Bob Duggar sent an e-mail to ABCNews.com earlier today about his wife's and daughter's condition. "Hello from the Duggar Family," he wrote. "We are so grateful for all of the prayers and emails of support for our family since Josie Brooklyn Duggar was born 12-10-09. Michelle is [recovering] from the emergency c-section and is doing [a lot] better. Josie is beautiful and in stable condition."
Ruark said she expects Michelle to stay in the hospital "for a while."
Back home, her other 18 children are "doing quite well" with the help of their grandmother, Jim Bob's mother, Mary, who lives with them. "They have lots of help," Ruark said, "and a big circle of friends. I'm sure they want mom home but the family just takes care of things."
Ruark said some of the older children were on a mission in El Salvador -- a trip family members have taken for about four years in a row -- when Josie Brooklyn was born. Their family insisted they finish the mission but they kept in touch by calling every day.
Now they all await the day their new sister can come home. Until then, however, they can keep a watch on Josie Brooklyn through the hospital's high-tech monitoring system.
Each bassinet in the neonatal intensive care unit of the University of Arkansas for Medical Sciences hospital is equipped with "angel-eye cameras," according to the hospital spokeswoman, which allows family, via a password, to view the baby from their home computers.
Each room is also private and equipped with a pull-out sofa to encourage parents to visit and stay with their babies.
Ruark said there have been round-the-clock prayers worldwide and the family is focused on Josie Brooklyn getting stronger and not on why and how this happened. "Really, it is God's will," Ruark said. "There is no second-guessing."
For now all eyes are on "micro-preemie" Josie Brooklyn 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.
A Uterus in (Too Much?) Use
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.
Pregnancies Can Get Complicated after Double Digit Births
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.
Many Pregnancies Cause Incontinence?
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.
Other doctors say it is not so much the number of pregnancies that put the average women at risk as her age.
"From an obstetric point of view, the number of children is less important than the maternal age at time of birth, history of obstetric complications, and general maternal health," said Dr. Lauren Streicher, assistant professor of obstetrics and gynecology at the Feinberg School of Medicine in Chicago.
For example, older parents are more likely to have children with genetic abnormalities such as Down syndrome. The Mayo Clinic also points out that older woman are also more likely to develop preeclampsia -- the condition that sent Michelle Duggar in for an emergency C-section Thursday.
Despite all the risks, Duggar has shown the human body is capable of reproducing successfully for decades.