The Duggar family, stars of the TLC reality show "18 Kids and Counting," make raising a large family look like, well, child's play.
Indeed, Michelle and Jim Bob Duggar of Springdale, Ark., recently announced that they are not done yet -- and are, indeed, expecting their 19th child.
Adults who have grown up in Duggar-size families, however, say it's a mixed blessing. Finding space to be alone is a challenge. Finding someone to play with is not.
There's also an environmental effect -- think carbon dioxide -- as well as health concerns for the mother. Women who've borne more than five children risk hemorrhage and even the loss of their uterus because repeated pregnancies sometimes thin the walls of the uterus, said Dr. Joanna Cain, an obstetrician-gynecologist in Providence, R.I.
Then there's always the possibility of one child getting lost in the passel of children.
Rachel Carroccio, a receptionist and ceramics teacher in Little Rock, Ark., knows that experience firsthand. The fifth-born of 10 children, Carroccio, now 28, recalled one time when her mother was in a hurry to get to the grocery store.
"We all piled into the minivan," she told ABCNews.com. "Mom counted heads to make sure everyone was there. As soon as she pulls forward, she sees my little brother Daniel riding his bike in front of us."
As it turned out, one of the heads was really the neighbor's.
But, for all the fond memories, she says the older girls in the family, including herself, burned out on caring for younger siblings and the house while her mother, often raising them alone, worked outside the home.
"None of us really want many kids," Carroccio said, referring to the girls. "My brothers, on the other hand, all want to have kids. I have one brother about to have his fifth child."
Those are among the sentiments the Carroccios like to share whenever all 10 -- ranging in ages from 11 to 37 -- get together for Thanksgiving and Christmas, their favorite time of the year.
Christmas was also a favorite time for Henriette Peters, the 11th child of 14, growing up in Crystal Lake, Ill., outside Chicago.
Big Families Stretch a Dollar
Even though the family had little -- no car, often no running water, spotty plumbing and heat -- Christmas was always a time of plenty.
"There were benefactors," Peters, now 48, told ABCNews.com. "We always thanked God for our benefactors. Our Aunt Dottie would send us pajamas every year in a special package from Marshall Field's."
Unlike the Duggars, who live debt-free in a 7,000-square-foot home on 20 acres, many big families have fewer resources to go around.
"My mother didn't live from month-to-month or year-to-year," Peters said. "She lived day-to-day. She had a faith in the Lord Jesus to care for her children. She calls it miraculous that we survived the conditions we lived in."
Peters said wearing hand-me-down clothing wasn't so bad, but not being able to get to the doctor without a car or money was hard. She said she still deals with "gushy gums" and "charley horses" from the years of eating foods with poor nutritional value.
Carroccio said her mother faced similar financial issues, but knew how to "stretch a dollar." It wasn't until she went to college that she realized not everyone ate potatoes at every meal.
"That was one of my mom's ways to fill us up, inexpensively," she said.
What the Peters lacked in resources, they made up in relationships, especially among siblings.
"The siblings cared for one another," Peters said. "I was cared for by my mother and my older siblings."
The Duggar family has a similar approach, with older siblings helping to take care of the younger ones.
Nineteen Kids Seems a Bit Much
Matt Hersh, an expert on children and adolescent fear and anxiety at Boston University, said that's not necessarily a bad thing, depending on the expectations the parents set up for their children.
"If that's an expectation, as in that's just how we function, it may not be perceived as burdensome," he said.
"In my limited knowledge of the Duggar's philosophy -- that every child is a particular gift for the family -- I imagine that would help ease the role."
To this day, Carroccio said, she remains very close with her second-oldest sister -- "she was like a second mom to me." At 18, Carroccio moved in with her older sister and still turns to her when she has a problem.
Still, thinking about the Duggars' having their 19th, Carroccio said, "I feel like it's too much. I'm sure no one is going to be neglected. But it does seem overwhelming."
Peters said she recalled looking out the kitchen window of her childhood home one day while washing a huge pile of dishes and thinking, "I can't wait till I get out of here."
She said she never wanted a big family. Then, she met her husband, Don Peters, a technology and computer specialist, and they married when she was 18. Five years later, they bought the property where her childhood home stood and built a house. They have since filled it with 10 children, ranging from ages 4 to 28.
"I never wanted to have a big family because I lived in one," said Peters, a stay-at-home mom. "But it came about through the love between my husband and me. Children are a gift from God, and God knew what was going to be right for us."
Duggar, 42, Made to Have Babies
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."