Nine weeks into the pregnancy that I hoped would result in my rainbow baby, I climbed onto the ultrasound table, too afraid to open my eyes to face the screen that would show me what I feared the most: another blank ultrasound. The beating heart I had seen only weeks before, gone. The baby I had been afraid to hope for, slowly vanished.
Through my tears, my midwife outlined my options for me. As with my previous loss, my body had failed to realize that it was no longer sustaining a viable pregnancy. Twice in a row, I had what is called a “missed miscarriage,” where the fetus had died but my body was still carrying on like I was pregnant.
Because I had already been through a loss once, I asked my midwife about the possibility of choosing a D&C (dilation and curettage) to end the pregnancy. Like many women who face the difficult decision of what to do in a loss, I had a lot of questions, concerns, and fears about the procedure and recovery. If you’re wondering if a D&C might be right for you, here’s what you need to know.
A D&C procedure is dilation and curettage, when a doctor dilates your cervix and uses a special tool to remove the contents of the uterus. According to G. Thomas Ruiz, M.D., an ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, there are actually two types of D&C procedures that doctors use.
One is commonly used during gynecologic exams when doctors are testing the uterus for abnormalities. The other is typically a suction dilation and curettage, known as a uterine aspiration, used for missed miscarriages, incomplete abortions, or to end an unwanted pregnancy. Dr. Ruiz says that a uterine aspiration procedure is used for pregnancies up to 12 weeks. A D&C is used in about half of all miscarriages.
When a woman experiences a missed miscarriage, she typically has three choices: medication to induce the miscarriage, waiting to see if the miscarriage will happen on its own, or a D&C. And while the decision is ultimately up to the mother, of course, Dr. Ruiz explains that the preferred method for pregnancies under 10 weeks is typically the medication route because the risk of complications is lowest. That being said, however, every loss and woman is different and there may be circumstances when a woman would elect to have a D&C instead of inducing the miscarriage at home.
For example, Kelly Burch, 28, a writer from New Hampshire, found out that she suffered a missed miscarriage at 9 weeks into her second pregnancy. The fetus had stopped growing at 6.5 weeks, but like me, Burch had not yet physically miscarried. She waited three days to see if her body would start the process of physically miscarrying on its own. After experiencing no results, Burch knew that a D&C was the right option for her.
“I couldn't take the emotional turmoil of waiting, especially knowing that my body had already been ‘waiting’ three weeks,” she explains. “At that point, I knew I needed the physical aspect done.”
The risks of a D&C depend on how far along you were in your pregnancy and how much tissue there is to be removed. Even though I was technically 9 weeks along, I didn’t have any fetal tissue left, as my body had absorbed it. Other women, like Burch, have fetal tissue and other contents of pregnancy that need to be removed during the D&C.
A uterine aspiration is very safe and effective, with less than 1/1000 women undergoing a major complication, says Sierra Washington, M.D., MSC, FACOG, and the associate professor of reproductive medicine at the University of California San Diego. The procedure is also very quick and can be performed in a doctor's office or an operating room in only 5 minutes or less. According to Dr. Washington, there are no documented risks to future fertility when a woman undergoes either a D&C or uterine aspiration.
Some of the most common complications from a D&C procedure include infection postoperatively, having a hole in the uterus, or scarring of the uterus. And the more D&C procedures a woman has done, the higher her risk of complications gets. The risk of Asherman's syndrome, infertility caused by uterine scarring, goes up with each D&C procedure.
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While many women fear that a D&C poses a risk to their fertility, some doctors actually believe that a D&C can be a more effective route to ensuring all contents of the uterus are removed cleanly. In Burch’s case, her doctor assured her that the D&C would help remove the tissue so she would be able to try for another pregnancy as soon as she felt ready. If a miscarriage happens on its own or medication is taken to induce a miscarriage, there is a risk of tissue remaining in the uterus.
However, one study out of Amsterdam indicated that having a D&C could be associated with preterm birth in future pregnancies. The scientists analyzed 21 different studies and discovered that the surgery is connected with a 29% greater chance of preterm birth (less than 37 weeks) and a 69% greater chance of very preterm birth (less than 32 weeks) in a subsequent pregnancy. Nearly 2 million women were included in the report and the risk of prematurity in future pregnancies was even higher in those with multiple past D&Cs.
But if you've had the procedure don't worry too much: the overall risk was around 6% in women without a prior D&C and the procedure brought that figure up only slightly to 7.6%, the equivalent of 16 preterm births per 1,000 women with D&C.
Dr. Ruiz says that the total recovery time from a D&C procedure is about two weeks. Most women will experience postoperative pain and cramping that typically lasts 3 to 4 days and some spotting that can last up to two weeks. Any pain is typically managed with a nonsteroidal anti-inflammatory drug (NSAID) such as Motrin. Dr. Washington typically advises her patients to avoid sexual intercourse for about a week after the procedure, but they can usually return to work the following day if they wish.
For Burch, the recovery time was minimal. In fact, she had her procedure on the morning of her daughter’s 3rd birthday. Burch hosted a lunchtime birthday party, then sent her daughter away for the weekend so she could properly rest and grieve. She noted that she had barely any bleeding or cramping and that she even felt well enough to go out later in the afternoon of the procedure.
Ultimately, the decision of choosing a D&C over another option for a miscarriage is something only you can make. I know how incredibly difficult the decision can be and I know exactly how it feels to wish, more than anything, that you didn’t have to make any decision at all.
For Burch, choosing a D&C ended up being much easier, both physically and emotionally, than she had initially expected. And after the procedure, she and her husband were able to successfully conceive four months following their loss. Burch is now in her third trimester with her rainbow baby and says that her only regret about her D&C is waiting as long as she did before making the decision.
“I wish I had done it sooner,” she says.
While deciding if you should have a D&C, speak with your doctor or midwife about any medical considerations before moving forward. For some women, using medications like misoprostol, the prostaglandin commonly used to induce labor.
"The advantages are that it's not a surgical procedure, doesn't involve anesthesia, has a high success rate (95%) before 9 weeks, can be done in the privacy of your own home, and can mean avoiding long-term complications of uterine scarring, cervical weakening, and preterm labor," says Dr. Sheryl Ross, OB-GYN and women's health expert in Santa Monica.
The disadvantages, however, include the time it may take (days or weeks) to complete and the potential for pain with longer periods of bleeding.
But in the end, know that there is no “right” way to go through a miscarriage. The most important thing for you to remember is that you can only make the choice that will best serve your emotional and physical needs.