Nothing about going to the doctor, especially your obstetrician or gynecologist, ever feels easy. These days, just walking into your clinic or doctor's office can make you feel like you're on trial for a crime you didn't commit, especially with the Supreme Court overturning Roe v. Wade. And for people who have miscarried, hearing the term "D&C" can be simultaneously confusing and terrifying. Many of us have heard talk of this procedure from our moms or other friends. But what is a D&C exactly? What do those letters stand for? Most pointedly, what can you expect, and why might you need one, aside from having a miscarriage?
The truth is that a D&C procedure isn't an enjoyable experience, but it's probably not as awful as you'd expect either. It usually only takes 10 to 15 minutes, and you'll likely be able to go home the same day after a period of observation (barring any complications). As with all things health-related, though, there are potential risks and variable outcomes.
Here's what you should know about this procedure and what you can expect post-op.
What is a D&C?
D&C is short for "dilation and curettage." Dilate means "make wider or open." Curettage means "the use of a curette, especially on the lining of the uterus." What's a curette? It's a surgical instrument designed for scraping. A D&C usually takes place after a miscarriage in the first trimester. In the simplest of explanations, a D&C is when your doctor further opens your cervix so that they can get inside and scrape or suction any tissue clinging to your uterine walls.
You most likely won't feel much (if anything) during your procedure, thanks to anesthesia. If you opt to stay awake throughout the process, you may experience some cramping, which is normal. You'll also likely have a bit of residual cramping after it's over.
Who needs D&Cs and why?
The short answer to this is that anyone who can get pregnant may need a D&C. In fact, according to a study published by StatPearls in The National Library of Medicine, it's one of the most common procedures performed in the U.S. While a D&C is often discussed in conjunction with a miscarriage, you may need a D&C if you're experiencing any of the following:
- Unusual uterine bleeding.
- Bleeding after menopause.
- Unusual endometrial cells (often discovered during a routine test for cervical cancer).
- A miscarriage or having an abortion.
- Molar pregnancy.
- Excessive bleeding after labor and delivery to clear our placental remains.
- Noncancerous cervical or uterine polyps.
In many cases, a D&C acts as a diagnostic tool or therapeutic procedure for abnormal bleeding. Healthcare professionals can examine tissues obtained during the procedure under a microscope to help pinpoint potential problems. In the case of a miscarriage or abortion, a D&C serves to remove leftover tissue and help you avoid infection.
Remember that a hysteroscopy may also be paired with your D&C. A hysteroscopy is a procedure where your uterine cavity is inspected using a tool that goes into the cervix. This device is called a hysteroscope, a thin, flexible tube and often used during a D&C when a doctor is trying to understand and diagnose an issue.
What should you expect during and after your D&C?
- Follow your doctor's pre-procedural instructions. This could include what/when to eat or drink. It could also involve taking medication to help your cervix begin to dilate before your appointment.
- Wear comfy clothing. You're not going to feel like squeezing back into your white skinny jeans post-procedure.
- Arrange for a ride home. In most cases, you will be under some serious anesthesia. As such, you should absolutely not be driving home.
- You'll have anesthesia, though the exact kind (general, twilight, oral) will depend on numerous factors. All of this will have been discussed at your consultation appointment or over the phone with a nurse while planning your procedure.
- Lie on your back with your feet in stirrups, as is typical for most ob-gyn appointments.
- Your doctor will use a speculum to open your cervix further and examine the area.
- A series of rods will be inserted into your cervix, each with increasing diameter, to help continue dilating your cervix.
- Finally, your doctor will use either a sharp-edged spoon-like instrument (curette) or a suction device to remove the tissue from your uterine walls.
*There is also the possibility of perforation of the uterus, which is when the surgical device used for the procedure pokes through the uterus. This is more common in people who have been recently pregnant or gone through menopause. Often, perforation is a minor wound that eventually heals by itself, but if an organ or blood vessel is affected, doctors may do a second surgery to address it.
Depending on why and where you have your procedure, you might spend a few hours in recovery, where nurses and doctors can keep an eye on you and ensure you're not bleeding too heavily post-procedure. After your release, you may experience:
- Severe cramping for 24 hours post-procedure and light cramping for up to two weeks
- Light bleeding/spotting that can last from a few days to a few weeks
In the following days, take care of yourself and follow any aftercare instructions given to you verbally or in a packet. In general, remember to:
- Avoid strenuous activity for a few days.
- Use pads, not a tampon, for any bleeding.
- Don't take pain medicine that can thin your blood and make bleeding worse.
- Take the antibiotics prescribed to you by your doctor to avoid infection.
- Follow your provider's timeline regarding sex.
Are there any risks?
As with most surgical procedures, a D&C does come with some risks. According to the American Pregnancy Association, this may include:
- An adverse reaction to anesthesia.
- Hemorrhaging or heavy bleeding.
- Uterine infection or infection in other pelvic organs.
- A perforated or punctured uterus.
- Laceration of weakening of the cervix.
- Cervical or uterine scarring.
- An incomplete procedural that requires repeating.
Are D&C procedures illegal now?
With the overturning of Roe v. Wade, many questions about reproductive healthcare and criminalization have surfaced. Currently, D&C procedures are still legal. However, the phrasing of many abortion restrictions and fetal harm laws leave room for D&Cs — and miscarriage in general — to be criminalized.
"The challenge is that the treatment for an abortion and the treatment for a miscarriage are exactly the same," Dr. Sarah Prager, professor of obstetrics and gynecology at the University of Washington in Seattle, recently told KHN, adding of the implications in a post-Roe world, "I think there's going to be a myriad of unintended consequences. I think that people will lose their lives. I also think that there will be people in horrible situations, like those that strongly desire to be pregnant but have a complication of the pregnancy, that will not be able to make decisions on how that pregnancy ends, and that will be a different kind of devastation."
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