Caroline Langguth feared she may never be able to have children after being diagnosed with type 1 diabetes as a 16-year-old.
More than a quarter of a century later, she's preparing to give birth for the 14th time, excited to find out whether she's having a girl or a boy.
"I'd always wanted a large family," the 43-year-old says.
But when she married her husband Alex, she was concerned fertility would be an issue because of her chronic condition — in which the pancreas produces little or no insulin, which usually helps regulate sugar levels in the blood.
She needn't have worried.
After marrying as a 20-year-old, the practising Catholic quickly fell pregnant with her eldest child Thomas, now 22.
She's since given birth to Sam, William, Bridie, Felicity, Suzannah, Celina, Kateri, Charlotte, Andrew, Rita, Evelyn, and Joseph.
"Every single time we've fallen pregnant has been this overwhelming excitement because we weren't going to have these children, it just wasn't going to happen," says Mrs Langguth, who has daily insulin shots to survive.
"We just never put a number on it. Every time they turn up … thank you God for giving us another one."
Family a 'visual depiction' of a midwife's work
A constant throughout every one of her pregnancies has been midwife diabetes educator Annette Parry, based at the Mater Mothers' Hospital in Brisbane.
Reflecting on Ms Parry's influence on her life, Mrs Langguth refers to recent photos of her big brood — taken on the family's property at Logan Village, south of Brisbane.
"If you could put into a single picture the importance of Annette's work, you just look at a picture of our family," she says.
"You hear about people who have vocations — Annette has dedicated her life in this vocational manner to be able to help women like me. I hope Annette sees the pictures and just thinks: 'Wow, I've done that'. It's a visual depiction of her life's work.
"She's always been there and she's sincere and passionate and dedicated in a way that I have very much admired and looked up to."
Ms Parry has spent the past 35 years working with pregnant women who have diabetes — whether it's type 1, type 2 or gestational diabetes.
She's helped hundreds of them — all are considered high-risk pregnancies.
"When a woman is pregnant, that beautiful placenta, the hormones that keep the whole pregnancy healthy, increase the woman's insulin resistance," she says.
"It doesn't matter what sort of diabetes you've got; you've got to look at the challenge of trying to keep your glucose levels in the best range you possibly can.
"People like Caroline with type 1 diabetes often don't need a huge amount of insulin, but they will need up to three times the amount of insulin that they normally take at the end of a pregnancy.
"You've got to say to them: 'You know, this is really normal because you've got a placenta that's growing, and the hormone levels are increasing'."
Progressive improvements in treatment
Mater senior staff specialist in endocrinology and obstetric medicine, David McIntyre, says the health service cares for about 500 to 600 pregnant women with diabetes requiring insulin injections each year – and the number is growing.
In the past women with type 1 diabetes, such as Mrs Langguth, may have been advised against falling pregnant because of the high risk, according to Emeritus Professor McIntyre.
But he says progressive improvements in treatment, including continuous glucose monitoring and insulin pumps, means "most women with diabetes can expect to be able to have a successful pregnancy and a healthy baby".
"There are very few women now who we'd see and advise totally against undertaking a pregnancy with type 1 diabetes, or type 2," Professor McIntyre says.
"But it's still a mammoth effort for a woman to manage her diabetes even through one successful pregnancy.
"Most people seem to find one or two or three exhausting, with the amount of effort they have to put in."
Insulin-dependent women during pregnancy require more regular ultrasound scans, blood tests and overall monitoring than mothers-to-be generally.
Not unlike many women with diabetes, Mrs Langguth's babies have been bigger than average as they have developed during pregnancy.
She went into labour with William but, in every other pregnancy, was induced two to three weeks ahead of her due date.
The Queensland mum has foregone pain relief for all but her first four deliveries.
"I don't use pain relief, simply because I find it distracting," says Mrs Langguth, who has spent more than nine years of her life pregnant.
"It's much better if you can be more in tune with your body and be aware with what's happening.
"That way you can more confidently deliver a healthy baby rather than panicking — that's what I've found anyway."
A friend as much as a midwife
The Langguths bought a three-bedroom house with a sleep-out on five acres about 10 years ago.
They built in underneath, expanding to seven bedrooms.
But they've made do with one bathroom ever since.
That will change in time for their 14th child, with the addition of another bathroom downstairs.
The family owns a small herd of Dexter cattle, which provides them with meat — they go through about 21 litres of milk and at least a dozen loaves of bread every week.
Asked how many nappies she's changed during her life, Mrs Langguth replied: "You go through at least two to three nappies a day, and then you can have up to three children in nappies at a time. I don't know, where's a calculator?"
"It would have to be thousands," she estimates.
Creating a big family hasn't come without some heartache.
Sam, the Langguth's second son, died in his cot at just five months old in 2003, and Bridie was diagnosed with leukaemia before her fifth birthday. Andrew has also had some health issues, undergoing recent orthopaedic surgery to stretch his right lower leg bone.
Bridie is in Year 12 this year and hopes to pursue a career as a cancer nurse.
After caring for Mrs Langguth throughout all her pregnancies, the health professional remembers the children's names and takes an interest in what they're up to.
"All the kids are fabulous," Ms Parry says.
"They're very helpful, they're very respectful. She and Alex have done a wonderful job with all of them to raise them to be such nice young people.
"It would be nice to know how they progress in their life, what they actually do."
As Mrs Langguth prepares to deliver her 14th baby in August, she describes Ms Parry as a friend as much as a midwife.
"I do have a genuine, sincere respect and admiration for a woman who has dedicated her life to helping women like me," she says.
