Duggars expecting 20th baby: But is it safe?

If anyone knows about the risks of bearing 20 children, it would be Dr. George Macones, chair of the American College of Obstetrics and Gynecology’s obstetrics committee.

But even Macones was a bit stumped when asked how Michelle Duggar’s latest pregnancy might affect her health as well as that of her baby. Jim Bob and Michelle Duggar, stars of TLC’s “19 Kids and Counting,” revealed Tuesday on TODAY that they are expecting baby number 20 in April.

“There’s no information out there about somebody having this many babies. That, I think, makes us nervous,” says Macones, chair of obstetrics and gynecology at Washington University in St. Louis, who’d never heard of the Duggars until TODAY.com contacted him.

Among his patients, Macones says, the record has been nine or 10. “I’ve seen nothing close to 20.”

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Dr. Nancy Snyderman, NBC's chief medical editor, said that Michelle Duggar's age means her doctors should keep close watch on her pregnancy. "She’s a high-risk pregnancy because she’s 45, and because that uterus can’t have any spring in it anymore," Snyderman said on TODAY's Professionals. "I mean, really, it’s gotta be like a water balloon that has no tensile strength.”

Any woman expecting her 20^th baby is going to be an older mother, which carries its own risks no matter how many children she’s delivered, Macones says. Two of the main ones, he says, are gestational diabetes and preeclampsia, which is more common in the oldest and the youngest of moms.

Michelle Duggar suffered preeclampsia during last pregnancy. Her blood pressure soared and protein appeared in her urine. To save Duggar’s life, doctors had to deliver daughter Josie three-and-a-half months early. She weighed only 1 pound six ounces and experienced a number of health problems, but she’s now a healthy toddler who will turn 2 in December.  However, some problems related to prematurity don’t become apparent until a child is in school.

Michelle Duggar said her doctor told her that her risk may be a bit higher but that she's in great health. "We're just trusting this is going to be a great pregnancy, full-term, healthy mom and healthy baby," she told TODAY Moms in an exclusive backstage interview.

Once a woman has had preeclampsia, the risk of it in future pregnancies increases, Macones says.

Any woman who’s delivered a large number of babies vaginally also faces an increased risk of bleeding after delivery because her stretched-out uterus can’t contract down to its normal size as well as it used to, Macones says. Excessive bleeding can lead to the need for an emergency hysterectomy.

Unless the Duggars are planning a home birth, they might want to check into the hospital as soon as she feels the first contraction. As Macones notes, “in general, the more kids you have, the shorter labors tend to be.”

More on the Duggar family:

Michelle Duggar announces she's pregnant with 20th baby
Video: What the Duggar kids really think about the new baby
TODAY Moms: Which 'J' name should the Duggars use for their next baby?