What a D&C Is:
A D&C, or dilation and curettage, is a surgical operation in which a doctor dilates your cervix and empties your uterus by gently scraping the uterine lining.
Although D&C is used as a general term for surgical treatment of a miscarriage, in the first trimester the procedure is usually a D&A (dilation and aspiration), meaning the doctor uses a "suction curette" rather than a sharp curette to empty the uterus.
Why a D&C Is Used for Miscarriage Treatment:
Sometimes a D&C is medically necessary. If a woman has unusually heavy bleeding as a miscarriage complication, a D&C can even be lifesaving because it stops the bleeding at the source.
In other cases, a D&C might be used if the doctor feels the miscarriage is unlikely to complete without intervention. In still other cases, some women request a D&C because they prefer to get the miscarriage over with rather than waiting for it to begin naturally.
Benefits of D&C:
Women who have D&Cs have lower rates of unplanned hospital admissions than women who have miscarriages with medical intervention or no intervention. Psychologically, a D&C can also have benefits in that it ends the physical part of the miscarriage much more quickly. A D&C may also make it easier to collect a usable tissue sample for couples who want to pursue chromosomal testing on the baby.
Risks of D&C:
A D&C carries a small risk of complications such as puncturing the uterus, weakening the cervix (increasing the risk of later cervical insufficiency), and of scarring in the uterus. These complications are rare but can occasionally occur. Reactions to anesthesia medications are another minor risk.
Personal Preferences and D&C:
Personal preferences vary heavily. Some women feel that a D&C is more emotionally traumatic than a natural miscarriage; they may simply prefer to let nature take its course and to avoid invasive procedures. Most doctors will respect the woman’s wishes in cases where natural miscarriage does not pose an immediate risk to the woman’s health.
Preparing for a D&C:
A D&C can be performed either in a hospital or a doctor's office. If your D&C takes place in a hospital, you will have to check in and usually undergo a few routine presurgical tests. You may be asked to avoid eating and drinking for a period of time before the procedure.
What to Expect:
The experience of a D&C depends on the type of anesthesia. With local anesthesia, the physical procedure will be like having a pelvic exam. A speculum is inserted into the vagina, the local anesthesia is given, and the cervix is dilated for the procedure. You may have moderate to severe cramping during the procedure. If your doctor uses general anesthesia or local anesthesia with sedation, you may simply wake up in a recovery area afterward without any memory of the procedure. (Many women prefer this option.)
Recovering and Coping after D&C:
Physical recovery should be relatively swift. Most women can go back to work after a day or two. The doctor can prescribe pain medication as needed for recovery. You may have vaginal bleeding and cramping for a few days, but it should not be severe or heavy. Contact a doctor if you have heavy bleeding or severe cramping, or if you have symptoms of infection. Your doctor will probably advise avoiding tampons and sexual intercourse for one to two weeks.
Most women will resume a normal menstrual period within six to eight weeks after a D&C, depending on how far along the pregnancy was when the miscarriage happened. Your doctor may advise waiting one to two menstrual cycles to begin trying to get pregnant.
D&C Procedure After Miscarriage. American Pregnancy Association. Accessed: Dec. 29, 2007. American Pregnancy Association. http://www.americanpregnancy.org/pregnancycomplications/dandc.html