Doctor, your patient is here to see you. She’s 45 years old, having her 20th baby, and has a history of severe preeclampsia, premature delivery and four prior cesarean sections.
As an OB/GYN, this scenario is your worst nightmare.
Michelle Duggar, supermom star of TLC’s 19 Kids and Counting, announced Tuesday that she’s pregnant with her 20th child. And while most people wonder why anyone would want to give birth to twenty kids, as physicians, our biggest question is why would she take the risk—one that jeopardizes both her life and her unborn child.
Michelle’s last baby was born three months prematurely, due to severe preeclampsia, and weighed only 1 pound 6 ounces. While the little girl, now less than two years old, ultimately survived and was discharged from the Neonatal Intensive Care Unit after four months, the long-term effects of the prematurity, including cerebral palsy, learning deficits, or behavior problems, are not yet known.
Since her preeclampsia occurred prior to 30 weeks, the risk that the preeclampsia may return in this pregnancy is at least 40 percent. Preeclampsia, or hypertension of pregnancy, can cause stroke, seizures, liver rupture, respiratory failure and maternal death. Its onset can be rapid and without warning. This disease is responsible for 15 percent of maternal deaths worldwide, and there is no prevention. While Michelle survived last time, there’s no way to predict if she will be as lucky.
The surgical risks of a fifth cesarean section also cannot be downplayed. Even after just one cesarean, a woman can experience extensive scarring, which causes the operation to be technically challenging. She can also endure damage to the surrounding organs such as the bowel and bladder. And the chance of another life-threatening condition, placenta accreta—in which the placenta grows into the scar of the uterus—increases dramatically. In these cases, a mother’s placenta can’t be removed after delivery, and she can experience hemorrhage, often requiring a hysterectomy. Even with the best surgical planning, the maternal mortality from this condition is 7 percent.
Clearly, every family has the right to choose how many members it will have. But purely from the medical perspective, Michelle is putting herself, and her unborn child, at risk. She and her daughter seem to have escaped the last time without major problems—though some would consider a four-month stay in intensive care a significant setback. And the risks are even higher this time around. We’re sure their 20th “blessing” is causing her OB/GYN a lot of sleepless nights.