What is a D and C and why do women get them?
The procedure known as a D and C or dilation and curettage is an out-patient surgery done by a gynecologist. It is one of the most common procedures performed on women. While it is technically a surgical procedure, it is not considered to be a complicated or risky procedure and recovery time is short. A woman is usually put under general anesthesia, so she is asleep and completely unaware during the procedure. The cervix is dilated and either a tool is used to scrape the surface of the uterus or suction is used to vacuum out the contents of the uterus.
The majority or D and Cs are performed after a miscarriage. When I was pregnant for the second time, the baby stopped developing at 7 weeks but I didn’t find out until 12 weeks during an ultrasound. I had miscarried the fetus but my body had not expelled the “tissue” as the doctor called it, from my uterus, so the OBGYN recommended a D and C. Some women have a D and C for a first trimester abortion but that is becoming less common now because there are many less invasive means being available. Other reasons to have a D and C are to treat or to diagnose causes of a heavy or unusual menstrual flow, or for other treatment or diagnostic purposes.
Preparations for a D and C
When I had the D and C, I was told not to eat or drink anything after midnight the night before the operation. I could drink water until four hours before the operation, which was scheduled for 10 am. We arrived for the outpatient surgery three hours in advance. They said I couldn’t drive after the procedure due to the medication being in my system, so plan to have someone else drive you and stay with you for a while at home. After filling out paperwork, we sat in a waiting room for two hours – so bring a book! One hour before the procedure was set to begin, a nurse brought me back to a room and told me I needed to remove all my clothes and jewelry and gave me a hospital gown to wear. The jewelry can interfere with some of the equipment, they said. I was able to give it to my husband before the procedure.
Then I got into a hospital bed and got an IV into my wrist, running saline water only. My husband was able to come sit with me until the surgery. The anesthesiologist asked questions about my medical history and my history with anesthesia, and an nurse told me about risks and had me sign a paper saying I understood the risks.
Risks and Complications of a D and C procedure
Some of the risks are:
- Infection of the uterus, fallopian tubes, cervix or vagina, especially is the woman has an untreated sexually transmitted disease
- Bad reaction to anesthesia
- Poor reaction to the instruments used in the surgery
- Uterine perforation where a tool pokes through the side of the uterus. This is more common when a sharp tool is used to scrape, rather than the vacuum procedure.
- Scar tissue in the uterus, especially if a woman has more than one D and C, which can increase the risk of complications in future pregnancies, such as ectopic pregnancy when an egg implants in the fallopian tubes rather than the uterus; miscarriage; abnormal placenta.
The doctor came in to answer questions and told me that although all the risk exist, the surgery is very common and complications from a D and C are very uncommon. She said she has done thousands of these procedures and never had someone have long term problems – just some short term issues like bleeding or reactions to anesthesia. I’d recommend you make sure the doctor you’re going to has a lot of experience doing them, just in case.
What is it like to have the D and C surgery?
Orderlies wheeled my bed into a surgery room and a nurse placed electrodes for monitors on my chest, side of my chest finger. I was hooked up to machines to monitor my vital signs. The anesthesiologist put a mask on my face and told me to count backwards from 10. I think I made it to eight. The next thing I know he was telling me to open my eyes because it was all done. I didn’t think they had even started!
Does a D and C hurt?
I felt absolutely no pain during the surgery or in the hours following it. I was asleep during the surgery and completely unaware. I don’t remember anything from it. A few hours later I had some mild cramping and was a little sore, but it was less painful than PMS cramps I’ve had in the past. I took some Midol and slept a few hours. By that evening, I was up doing my normal activities without any problems.
Recovery from a D and C
After the surgery, they wheeled me back to the other room where my husband was waiting. I was still sleepy but after twenty minutes I was fine. They gave me juice and crackers and said I couldn’t leave until I urinated. When I did, the nurse checked it. I think she wanted to see how much blood there was. There was almost none - like a very light period. I got dressed, they took out the IV and wheeled me in a wheelchair out where my hubby had pulled up the car, even though I could walk fine.
The actual surgery took about 40 minutes, and I spent about 30 minutes sitting in recovery. I didn’t feel any pain, but I was starving afterwards! I felt good enough that we stopped on the way home and had lunch. Afterwards, I had spotting for about 3 days. It was very light and I just used a panty liner. The doctor told me not to work out at all for two weeks, and no strenuous workout for another week. She also said I should not have sex or use tampons for 6 weeks due to the risk of infection. She told us to wait three months before trying to get pregnant again.
Pregnancy after a D and C
Most women do not have problems getting pregnant again after a D and C, although complications are possible. For me, I got pregnant again five months after the D and C. I have had two other friends who have had D and Cs who have gone on to have more children.
Diagnosis of the fetus following D and C
If you have a miscarriage, it may be possible for doctors to diagnose the cause of the miscarriage using material removed during the D and C. In my case, I have an older daughter with a rare chromosomal disorder so there was concern that the same condition may have caused this miscarriage. We talked to our gynecologist and arranged in advance for the tissue removed from my uterus to be sent to a pathologist. They were able to take genetic material from the fetus and run a chromosome analysis on it. Sometimes this is not possible, depending on if they are unable to locate the fetal cells or if the cells are too old to use – for instance if the baby stopped developing weeks before the D and C. In our case, doctors were able to analyze the tissue sample and determine that the miscarriage was not due to the same condition that affects our daughter. This information may be useful to us in deciding whether to do an amniocentesis in the future.
IMPORTANT! Be aware that many insurance companies do not cover genetic testing or diagnosis of a miscarried fetus. Call your insurance in advance to verify what they’ll cover. If they will not cover it or they will not guarantee payment, ask your OBGYN’s office to speak to the lab that will do the analysis. Sometimes they will agree to give you a maximum payment amount. This guarantees that you will pay no more than the price they quote you, even if insurance covers nothing. Get the maximum payment amount in writing and if they try to make you pay more than that, argue with them until they stick to their original agreement.
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