Sometimes Fate has to shout in order to be heard, especially when the voice of reason is ignored. Michelle Duggar was pregnant with her 20th child to the aghast of many including this author. We squirmed in our seats. We moaned. We groaned. We blogged. The combination of Duggar’s 19 children and her advanced maternal age of 45 is enough to make any obstetrician or midwife cry, especially when she becomes pregnant, yet again. Not surprisingly, Duggar experienced a miscarriage with pregnancy number 20. According to media reports, when the Duggars presented for their ultrasound, a fetal heart beat could not be obtained. What occurred in obstetrical vernacular was a missed abortion or an early fetal demise. Based on the Duggars’ press release, his wife probably had no symptoms prior to receiving the ultrasound. The cramping, spotting, abdominal and back pain was probably absent. An early fetal demise without symptoms or missed abortion means the baby stopped growing because there was a condition present that was incompatible with life. Did Duggar’s age increase her chances of having a miscarriage? Absolutely. 93.4% of woman who are over 45 will have a miscarriage. Or put another way, only 6% of pregnant women over age 45 will deliver a baby. 7% of all women Duggar’s age will have an ectopic (tubal) pregnancy and 8.2% will have a stillbirth. One out of 19 pregnant women who are age 45 will have a baby with Trisomy 21 or Down’s syndrome. So should we be surprised that Duggar had a miscarriage? No. And no one is gloating over her misfortune. A miscarriage for any family, even those with 19 children is lamentable. However, most pregnant women who have experienced a miscarriage will attempt to conceive again. In the case of Duggar, this would be a profound tragedy. Mrs. Duggar, you have our condolences regarding your miscarriage. Millions of people enjoy coming into your home each week and think you are delightful. However it is out of our profound concern for your well-being that prompts us to implore you. Please don’t push the envelope any further. Please give your uterus a well-deserved rest.