But now the couple – who only recently brought baby Josie home after being hospitalized for six months as she recovered from a perforated bowel and rare digestive problems – say they are ready to consider a 20th child.
"Our family is stronger than ever," Jim Bob, 45, tells PEOPLE in its new issue. "We made it through the storm."
That's not to say that everything has been easy with baby Josie. Born early after Michelle developed preeclampsia (pregnancy-induced high blood pressure), Josie was just 8 days old when a perforated bowel threatened her life.
"When she first came home, I couldn't sleep at all," says Michelle, 43. "That was the scariest part for me, having the full responsibility of her care on my shoulders ... It was intimidating."
Similarly daunting are the very real medical risks Michelle could face with another pregnancy – particularly a return of preeclampsia, which can lead to a stroke or prove fatal. But despite the risk – and intense criticism – the pair vow to stick to their beliefs.
"People think we are overpopulating the world," says Jim Bob. "We are following our convictions."
For many more inside details of the Duggars' ever-expanding clan, pick up this week's issue of PEOPLE, on newsstands Friday
Watch 19 Kids & Counting Tuesday nights on TLC at 9 p.m. ET