By Diane Mapes, contributing writer

We all get busy at times, so overwhelmed with work, family, friends and obligations that we neglect our bodies. But how is it possible to be so out of touch with your body that you don't know you're about to give birth?

Easy, say the people involved with "I Didn't Know I Was Pregnant," a 10-episode reality TV show that tells the story of 10 women who conceive and carry babies full term without realizing they're pregnant.

"I think at first glance you think, how could a woman not know," says Wendy Douglas, director of production for the TLC network. "Clearly she's not paying attention or not smart or something. But that's really not the case."

Timothy Bullard / The Daily Courier

Bonita Ewen with 1-week-old Chance, who arrived seemingly out of the blue.

A host of circumstances can contribute to a stealth pregnancy, say doctors, starting with the fact that not all women experience the familiar nausea, weight gain, swollen ankles, food aversions and emotional ups and downs we've come to associate with pregnancy.

Pregnancy symptoms can really vary," says Dr. Michelle Evans, a reproductive endocrinologist from Pasadena, Calif., who's featured on the show. "Some women have very minimal or no symptoms. Other women will be throwing up every day."

Expectations can also come into play, say the experts. Some women will take a pregnancy test and receive a false negative. Or be told by their doctor they're unable to conceive. Moms who've just delivered a baby often (mistakenly) believe it's too soon to be pregnant; other women will be using birth control but for whatever reason – an expired condom, a missed pill, a course of antibiotics – the system will fail. Thinking there's no way they could possibly be pregnant, these women will attribute their symptoms to something else – morning sickness becomes a bad bout with food poisoning, swollen ankles are due to all the time they spend on their feet. They'll blame their weight gain on outside circumstances – stress from the job, the fact they recently quit smoking – or they simply won't gain that much weight in the first place.

"Some women only gain 5 to 10 pounds in their pregnancy," says Evans. "One woman on the show was taking all of these extra Pilates classes and working very hard at exercising because she was gaining weight and didn't know why."

Other women's weight will go up and down so much on a normal basis that the extra pounds don't seem all that strange.

But wouldn't these moms feel their babies kick?

"Everyone should have some fetal movement during the latter half of their pregnancies but there's absolutely a range," says Dr. Karen Wells, an ob/gyn at the Center for Women's Health at Evergreen Hospital in Kirkland, Wash. "If a woman is heavy she doesn't feel things quite as much and if the placenta is in the front, right under the belly, and the baby is below that, that's going to insulate it, too."

But if a woman doesn't believe she's pregnant, the movement of a baby will often be attributed to something else, says Evans.

"They may think they have indigestion or that there's something else going on that causes them to feel movement," she says.

Even old standbys like a woman's period – or lack thereof – can often prove to be unreliable indicators, say the experts.

"One of the things I saw in many of these cases was that the women had very irregular menstrual cycles," says Evans, who studied the case histories of the women featured in the show.  "Many were so irregular that their doctors told them 'When you want to get pregnant, we're going to have to help you because you're not ovulating.' So when they had symptoms during pregnancy, they attributed it to some other condition."

Spotting – which often occurs during a woman's pregnancy – was another factor that led to confusion. Women with irregular periods assumed an episode of spotting was simply their haphazard period showing up.

Psychological factors like fear and denial can also play a role in a "surprise" pregnancy.

"Our minds are our most powerful organs and there are people who really don't want to be pregnant and convince themselves that they're not," says Wells. "This happened twice during my residency. One time, a woman was in labor and was sure she wasn't pregnant even when the baby was crowning. Some people are in complete and total denial."

Although doctors say going full-term without knowing you're about to give birth is rare, TLC's Douglas says she's been inundated with stories of surprise pregnancies.

"Each time a show airs, we get a flood of letters from people saying 'This happened to me!' or "I know someone this happened to,'" she says. "I think right now we have well over 150 stories that we could tell."

Indeed, the news is full of stories of stealth pregnancies. Last December, a British mother of two gave birth to a 5 pound, 8 ounce baby boy, who she claimed never kicked during the entire pregnancy. And in March of last year, 38-year-old Bonita Ewen of Oregon thought she was having stomach cramps, but instead gave birth to a 6 pound, 3 ounce baby boy out of the blue, telling reporters she had gained 10 pounds but experienced none of the "signs and symptoms of a pregnancy … no nausea, no cravings, none of that stuff."

As in life, the unexpectant mothers featured in the show – which premiered September 30 –are from all walks of life. Some are in their late teens and early 20s, others are in their 40s (one woman was about to undergo a hysterectomy when doctors discovered she was on the verge of giving birth). Some have had children previously; others are new to the parenting game. One woman – who experienced no pregnancy symptoms whatsoever – tells the story of her two surprise deliveries, one at age 18 and another, three years later.

"Stealth moms" are found through e-0mails and letters sent to the show's producers following each episode and via the show's Web site.

Albeit unexpected, the babies are all healthy although considering the lack of prenatal care – and in some cases, the use of birth control pills or other medications – there are potential health concerns.  The mothers, while unprepared, are extremely excited about their surprise packages.

Since none of them knew they had a baby on the way, stories are told in flashback form, via interviews with the women and her friends and family (many of whom vouch for the mother's incognizance or lack of symptoms) and a series of dramatic reenactments.

And it can be dramatic, says Evans, who's seen a surprise birth in action.

"When I was a resident, I once saw a patient like this in the ER," she says. "A woman came in and and the family thought she had appendicitis or something horrible. They thought she needed surgery. I evaluated her and did a pelvic and I could feel a head. I said, 'Oh my gosh, we need to get her to labor and delivery right away' and everyone's jaw just dropped."

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By Brian Alexander, contributing writer

After South African runner Caster Semenya came out of nowhere to zip past a track of world-class athletes in the women's world 800-meter race in Berlin last month, spectators starting speculating that the muscle-bound 18-year-old was no lady. Her low voice and broad shoulders raised eyebrows and suspicions.

Now, newspaper reports from Australia say testing has determined that the running star has both male and female sexual organs – in other words, that she's a hermaphrodite, and likely didn't even realize it.

The International Association of Athletics Federations, which ordered the testing, refused to confirm or deny the reports and said it won't issue a final decision until the next meeting in November.

In the meantime, there is worry about how the 18-year-old from a poor village in South Africa will handle the scrutiny, and widespread curiosity about what "hermaphrodite" means, exactly.

The popular notion of hermaphrodite comes from the Greek myth of Hermaphroditus, the offspring of Aphrodite and Hermes. Hermaphroditus, the Zac Efron of his day, was so pretty that a nymph named Salmacis fell madly (literally) in love. In her desperation, she jumped into a pool of water, grabbing Hermaphroditus on the way in and pleading with the gods to unite them forever. The gods did exactly that, which is why statues of Hermaphroditus depict a figure with a woman's breasts and a man's penis.

But such pure she-males are more myth, or the result of partial transsexual surgery, than reality.

That's why, these days, the proper word is "intersex," a recognition that there are a range of conditions between rigidly "male" and "female" and that gender is as much a product of society and self-perception as it is a matter of what gear you have or chromosomes you possess. 

An intersexed condition can arise in a variety of ways, from a number of syndromes, but so called "true" hermaphrodites are often chimeric. In other words, instead of having cells with 46 chromosomes that include either an XX pair in women or an XY pair in men, they possess both 46XX and 46XY cells. Some may have one testicle and one ovary, or what are called ovo-testes, combo gonads comprised of both ovarian and testicular tissues. True hermaphrodism is thought to be rare, but according to the World Health Organization, no prevalence data is available.  

In Semenya's case, the Australian report says she has no ovaries and instead has internal testes, which produce large amounts of testosterone, explaining her muscular physique. It's likely she and her family may have been unaware of the condition because the male organs are on the inside. In many cases of the intersexed condition, the external genitalia appear to be female.

In the past, it was common for doctors delivering babies with ambiguous genitalia to simply assign a gender and order up a surgery to make the child match that gender. But as intersex conditions have come out of the shadows, there is much more discussion about appropriate options. These can include hormone replacements, counseling, surgery, or doing nothing at all, a path favored by many intersex advocates.

Intersex athletes have been an issue before. Stella Walsh, the 100- meter champion in the 1932 Summer Olympics in Los Angeles, turned out to be intersexed, a discovery made after she was murdered in 1980 in a Cleveland parking lot during a robbery.

The 1966 world women's downhill ski champion, Erika Schinegger of Austria, was discovered to have a version of a penis and testicles inside her abdomen. She later became a he, changing his name to Eric and becoming a father. Other famous "hermaphrodites" may include the Pardoner in Chaucer's Canterbury Tales, and Queen Christina of Sweden in the 1600s.

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By Diane Mapes, contributing writer

When Arkansas mom and reality TV star Michelle Duggar announced on the Today show Sept. 1 that she was pregnant with her 19th child, millions of Americans expressed joy and amazement. 

But others – undoubtedly the queasiest of the bunch – were a bit uneasy. How could one woman – or rather, one uterus – bear so many children? Isn't that, well, stretching things a bit?

Not necessarily, experts say.

"The uterus is a remarkably flexible organ," says Dr. Florence P. Haseltine, ob/gyn and founder of the Society for Women's Health Research in Alexandria, Va. "It can grow rather rapidly and it can recede rather rapidly. It's able to reconstruct itself and reconfigure itself quickly."

Beth Hall / AP

Michelle Duggar is surrounded by her children and husband Jim Bob, third from right, while she holds her newborn daughter, Jennifer Danielle, the couple's 17th child, on Aug. 2, 2007, in Rogers, Ark.

Haseltine says she understands how people would be amazed that one uterus could carry and deliver so many children – especially in a day and age when the average number of births per female is 2.12 – but it's a misconception to think that giving birth to 18 or 19 children is overtaxing the organ's ability.

"The sense is 'My goodness, I get physically tired just thinking about it, so therefore the uterus would be tired,' but that's not necessarily true," she says. "I don't believe a uterus gets tired. If it had damage as a result of a specific pregnancy, it might cause trouble. But it doesn't make any physiological sense why one should worry about the uterus."

Thanks to the wonders of reality TV – the family has their own show entitled "18 Kids & Counting!" on TLC – keeping track of Michelle Duggars' uterus has become sort of a national pastime. According to the family Web site, the couple married in 1984 and had their first child four years later. Since then, Michelle Duggar has given birth to an additional 17 children, including two sets of twins. Three of the births have been via Caesarean section; the others have been vaginal. She and her husband, Jim Bob, are currently expecting their 19th child (as well as their first grandchild).

While experts say good health plays a major role in any woman's ability to conceive, carry and deliver children, particularly multiple children, good genes are crucial, too.

"Everyone is different in their health, and with some women it takes more of a toll," says Dr. Karen V. Wells, an ob/gyn at the Center for Women's Health at Evergreen Hospital in Kirkland, Wash. "And women have different muscle tone in their uterus. Some people get saggier and baggier earlier on and some people have good tone to their tissue. It has to do with our individual makeup, our collagen, our elastic fibers, our genetics. I know someone who after just two children had to have her bladder resupported. Other people seem to do fine. Obviously Mrs. Duggar is a very healthy woman and her body is handling it well."

Not that there aren't concerns and complications when it comes to multiple pregnancies or "grand multips," as they're known. After delivering five or six children, women are more prone to post-partum bleeding or hemorrhaging. The risk for toxemia and preeclampsia also increases. Anemia can also be a concern.

"There's a continuous leeching of calcium and iron, the supplemental building blocks that babies need," says Dr. Peter Wall of Eastside Maternal Fetal Medicine in Kirkland, Wash. "After having many children, chronic anemia or osteopenia – weak bones – could be a chronic risk. Also carrying children does increase the risk of incontinence, but even women who haven't had children have incontinence."

And having lots of kids has health benefits, too, Wall is quick to point out.

"We know that having many kids protects from breast cancer and ovarian cancer," he says.

Labor, also, becomes shorter the more deliveries a woman has, although it doesn't necessarily become easier.

"The duration of labor is shortened, but that doesn't automatically translate into easier," he says. "You've been down that road before. The ability to cope with labor is probably better when you're naïve and 18."

According to the National Center for Health Statistics, the average number of births per female has gone up and down over the years, from 3.33 in 1917 to 2.17 in 1937 to 3.68 in 1957 to 1.77 in 1975. National averages aside, though, there have always been "supermoms," from Queen Victoria and Rose Kennedy who both had nine children to Mrs. Feodor Vassilyev, a Russian peasant who made the Guinness Book of World Records by giving birth to a total of 69 children, including 16 pairs of twins, seven sets of triplets and four sets of quadruplets.

Today, the average woman has about 2.12 children, although if desired, any woman could try for supermom status. The trick is to avoid contraception, be exceptionally fertile and be up for the challenge, says Wells.

"Having that many children isn't an oddity," she says. "I look back at my own family history and my great-grandmother had 10 children and five survived. The fact is most people don't want that many children today."

Those who do want lots of babies are encouraged to space their pregnancies out by at least 18 months, says Wall.  And to keep in mind that some women are simply more adept at baby-making than others.

"This woman has some remarkable capabilities," he says. "I think this is her special talent."

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By JoNel Aleccia

At last, good news for anyone who ever despaired of fitting into skinny jeans: Thin thighs might actually kill you. Or at least put a strain on your heart.

That's the word from Danish researchers who studied more than 2,800 middle-aged people for up to a dozen years, only to find that those with the slimmest thighs had the highest chance of heart disease and premature death.

"There was up to a double risk for the people with the smallest thighs," said Dr. Berit L. Heitmann, a director of research at Copenhagen University Hospital in Denmark. "It's quite substantial."

People whose thighs measured less than 60 centimeters, or about 23.6 inches in circumference, were in trouble. And those with stick-thin gams (less than 18 inches around) were at the greatest risk, according to new study in the online version of the British Medical Journal.

Stefan Gosatti / Getty Images file

By that measure, supermodels everywhere would be in grave danger, while those who one fitness expert described as "normal-sized people," would be in the pink. "Typically a 23.6-inch thigh on a female would be a size 6 to 8," said Greg Benson, president of the International Sports and Fitness Trainers Association.

A woman with thighs that size might be 5-foot-1 and weigh about 135 pounds, a few inches shorter and a bit heavier than the reported measurements for singer Beyonce Knowles, who is known for her curves. A man with thighs like that might be 5-foot-7 and weigh 160, about the reported size of actor Tom Cruise.

Although the reasons for the increased risk of small thighs isn't clear, it's likely that those with smaller limbs lacked the muscle mass and lower body bulk necessary to ensure proper glucose and lipid metabolism, key factors for more serious disease, Heitmann said.

"It would seem that having too little muscle or fat in that region would be a problem," she added.

Typically, of course, it's the other end of the tape measure that signals trouble: People with too much junk in the trunk – and everywhere else – are usually obese and at risk for host of fat-related ailments.

But Heitmann's study, which was started in 1987 and followed patients through 2002, found that people with thinner thighs had a 50 percent to 100 percent higher chance of developing heart disease within a decade or dying by year 12 than their chunkier companions.

The results were similar for both sexes, and, surprisingly, the thigh measurement stayed the same, too, noted Heitmann.

She was quick to add, however, that the study should not be interpreted as a free pass for people who want to skip the gym.

In this case, much bigger was not better. The protective benefits of heftier thighs didn't rise when thighs grew larger than 60 centimeters.

"There's no further advantage there," Heitmann said.

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By JoNel Aleccia

A disabling disease that can turn human hands into virtual claws may be eased or even cured by a new injectable drug, a study suggests.

The drug, called Xiaflex, could be an alternative to surgery for Dupuytren's contracture, a benign but often crippling disorder in which collagen cords form in the hand, curling the fingers immovably into the palm, according to a report in today's New England Journal of Medicine. The Food and Drug Administration approved the drug on Feb. 2.

Dupuytren's is named for Baron Guillaume Dupuytren, the 19th-century French surgeon who described the disease now believed to affect some 13.5 million to 27 million people in the United States and Europe.

New England Journal of Medicine

This patient's hand was involuntarily clenched like hook (left), until injections with an experimental drug.

Ronald Reagan had the condition. Britain's Margaret Thatcher has it, too. And J.M. Barrie, author of "Peter Pan," may have used his own experience with Dupuytren's as a model for the character of Captain Hook.

"It's claw-like, if you will," said Rod Van Sickle, 63, a retired Trabuco Canyon, Calif., firefighter who had to take a desk job after Dupuytren's ravaged his hands. He had three surgeries on his right hand to correct the recurring condition before it shifted to his left. (A common pattern for the mysterious condition.)

Then Van Sickle joined a trial of 308 patients to receive injections of collagenase clostridium histolyticum, an enzyme that dissolves the thick cords that researchers say are stronger than steel. 

"If I could show you my hands right now, my left hand is perfectly straight after three injections in three months' time," Van Sickle said.

Results of the trial, funded by Auxilium Pharmaceuticals of Malvern, Penn., the drug's maker, report that the injections allowed nearly full or full extension in 64 percent of injected joints, compared to about 7 percent of joints injected with placebo.

Twenty-four hours after the injections, doctors manipulated the softened cords, which broke free with "an audible and palpable snap and a little burst of pain," according to Dr. Roy A. Meals, the study's chief investigator and a clinical professor of orthopedic surgery at the University of California, Los Angeles.

And that really hurts. Nearly 97 of patients in the trial reported pain, swelling, bruising or other problems.

The puzzling disease seems to be inherited and is related to hand trauma, smoking, alcohol and diabetes.

As it stands now, Meals said, only the people with the most severe cases, fingers bent to 30 degrees or more, are treated, and then usually with surgery, as was the case with Reagan and Thatcher. The others?  "We advise those people to live with it," Meals said.

Critics of the drug, which could cost as much as $1,500 per injection, say it will be as expensive as surgery and not necessarily covered by insurance.

In other pending trials, the drug is being tested for use to treat collagen build-up in other diseases, ranging from so-called "Frozen shoulder syndrome," in which scar tissue limits shoulder motion, to Peyronie's disease, in which plaques form along the penis, causing it to curve sharply to one side.

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