Arkansas mom of nineteen Michelle Duggar is in the news again today, having just given birth to her nineteenth child via emergency C-section. Jim Bob and Michelle Duggar, along with the eighteen children she had before the latest, have become reality television stars thanks to America’s curiosity about supersized families and their soon to be renamed reality show, 18 Kids and Counting. Duggar, 43, has been fortunate enough to have had eighteen healthy children. I suspect her nineteenth child will have some growing to do before she can be declared healthy. With that many children, Mrs. Duggar easily qualifies for the clinical medical term “grand multipara”.
I had never heard of the term grand multipara until I was discussing the Duggars with a friend of mine who is a nurse. According to www.medterms.com, a woman who has had five births qualifies for the diagnosis. “Birth”, as it relates to the term grand multipara pregnancy, means that a pregnancy has progressed to at least twenty weeks and has produced a fetus that weighs at least 500 grams. Michelle Duggar has now had nineteen children, which makes her a grand multipara almost four times over!
So what’s the significance of a grand multipara pregnancy? According to The Internet Journal of Gynecology and Obstetrics, prospective mothers who have already given birth more than five times qualify for the diagnosis of “high risk pregnancy”. The “high risk” label means that a prospective mother has one or more risk factors that may present problems for the mother or her unborn child during the pregnancy. Pregnant women who are identified as “high risk” may be encouraged to seek care at a medical center with advanced equipment and specialized staff.
Of course, just because a doctor identifies a prospective mother as “high risk”, that doesn’t mean she is doomed to have problems. It just means that medical staff may be more on the lookout for problems to arise. In fact, according to Ganesh Dangal MBBS; MD, a consultant gynecologist who authored a paper for The Internet Journal of Gynecology and Obstetrics, “with proper care, 90 to 95 percent of high-risk pregnancies produce healthy and viable babies” (2007).
Dr. Dangal also writes that mothers who have had more than five babies are at an increased risk of “rapid labor and postpartum hemorrhage due to uterine atony. Grand multipara are also at increased risk of a placenta previa” (2007). My nursing friend defined uterine atony as a uterus that has become “tired”. Indeed, the term refers to a uterus that has lost muscle tone, which may lead to an increased risk of uncontrollable bleeding. Placenta previa refers to a condition in which the placenta either partially or completely covers the cervix or lies adjacent to it. Placenta previa can also lead to bleeding.
Michelle Duggar has at least two risk factors for pregnancy, despite the fact that she has had so many healthy children. She is a grand multipara and, at age 43, she is considered to be of advanced maternal age. Recently, she was admitted to the hospital due to pain from gallstones that were causing her to experience contractions. Early news reports of Mrs. Duggar’s condition initially stated that it was unlikely that she would have to deliver her baby early, but evidently complications arose that required Josie Brooklyn Duggar to be delivered by emergency C-section on December 10, 2009. With an original due date of March 18, 2010, Josie was born approximately three months early. She weighed 1 pound 6 ounces at birth.
Celzic, Mike (2009). Duggar baby No. 19 arrives early. Online. http://www.msnbc.msn.com
Dangal, Ganesh (2007). HIgh Risk Pregnancy. The Internet Journal of Gynecology and Obstetrics.