Michelle Duggar, the mother of America's biggest family -- or at least its most well-known one, thanks to reality television -- was five months into her 19th pregnancy (after suffering the loss of one baby previously) when she announced earlier this week that she had miscarried. Duggar also announced that she plans to both name the baby and hold a funeral service.
As stars of the TLC series "19 Kids and Counting," Duggar and her husband, Jim Bob, have faced plenty of criticism for their approach to family planning -- or lack thereof. The announcement of this latest pregnancy was met with indignation by some, especially in light of the fact that the world had just welcomed baby number seven billion. A blogger for Babble even wrote a letter of resignation -- from the perspective of Duggar's uterus.
The pregnancy's end no doubt raises some uncomfortable but important questions: is there a correlation between the number of pregnancies a woman has and her likelihood of miscarrying? And what is the appropriate process for grieving a child who hasn't been born?
"The number of children is not the issue," said Dr. George Macones, an OB-GYN at Washington University in St. Louis, who explained that a woman's risk of miscarrying is increased by preexisting medical conditions, such as diabetes, and factors such as a weak cervix. After giving birth to 19 babies, Macones said, the latter is probably not why Duggar miscarried because the issue would have surfaced much earlier.
"There aren't lots of people who've had 20 babies out there, so we don't have lot of good data on it," he said. "But the risk is really related to how healthy somebody is. As [women] get older, there are more medical problems." In addition to the role the mother's health plays, the likelihood for chromosomal problems with the baby increases as the she gets older.
The risk of miscarrying in the first trimester is 15 percent, according to Macones, but in the second, it drops to just one or two percent. Conceptually, at least, it would seem that the farther along you are in a pregnancy physically, the more difficult it would be to cope with the loss emotionally. But studies don't support that assertion.
"Women themselves will say, 'How can a loss at 20-plus weeks be the same as a loss at six weeks?'" said Emma Robertson Blackmore, an assistant professor of psychiatry at the University of Rochester Medical Center who has studied moods during pregnancy, post-partum depression and the effects of miscarrying. "But research says the level of symptoms and impairment is the same.”
Though Duggar was six months along, the move on her part to name the child and hold a funeral service is both common and even beneficial, according to Robertson Blackmore.
"Some women just can't bear the thought of doing either. The shock is so much that they're almost in denial, whereas others feel it's very important to recognize the baby. A name literally names it. They can really let the grief process take its normal course," she said.
People frequently don't know what to say to a mother after she has miscarried, and well-meaning words of condolence are often hurtful. They include telling a mom that she'll have healthy babies in the future, or if she already has children, to remind her how lucky she is to have them.
David Kessler, co-author of On Grief & Giving has an entire list on his website of what not to say when someone goes through a loss. He suspects that, in light of how many children Duggar already has, sympathy for her situation may come in misguided forms.
"The reality is we do judge each other's grief," says Kessler. "And it's unfortunate, but she probably will get some judgment."
Correction: Michelle Duggar has been pregnant 19 times and was five months along when she announced, not six. The "19 Kids and Counting" couple have two sets of twins, and Michelle has experienced two miscarriages.