D&C versus Natural Miscarriage: What Actually Happens

After my recent post on Recurrent Miscarriage, questions came up surrounding preparing for a D&C. Specifically, the difference between a D&C versus natural miscarriage, what will occur, and how do I move on after. Unfortunately, have been through this situation often. I am also a member of several infertility support groups and have incorporated others’ experiences into this blog to provide a full view. My hope is that you will come away with clarity on if D&C is right for you, a full understanding of what will happen the day of, and what recovery entails. This blog will help those working through a first-trimester miscarriage.

My spouse and I decided on the D&C (Dilation and Curettage) for all four miscarriages. This is a personal decision on how you would like to handle your miscarriage. There is no right or wrong answer, and each situation is different and may require a different treatment path. Do your research! Talk to your physician to determine the best way for you to proceed. This is a hard situation and I am sorry you even have to figure out a plan. I have been in your shoes, along with so many other women. You will get through this.

Full transparency; I am not a physician, just a woman who has been through this situation often and recently. I live in the U.S. in a large suburb and have access to top medical care. If you have been in this situation before, I encourage you to help others by sharing your experience in the comments.

What is Miscarriage: D&C versus Natural Miscarriage

Miscarriage is painful, both physically and mentally. Many women silently suffer. According to the March of Dimes, it could be as much as 50% of all pregnancies end in miscarriage but only 10-15% are diagnosed due to the woman even knowing she was pregnant. If you are in a situation where a miscarriage is imminent, you have several options. The tissue may expel on its own or you may require surgical intervention. This section discusses the differences between a D&C versus natural miscarriage.

What is a D&C

I had a D&C each time, primarily to collect chromosomal information to better advise our next protocol and secondly to minimize emotional trauma. It is difficult to go to the hospital, know what is happening, and undergoing anesthesia, however, the process only lasts only one day.

The first step when deciding if a D&C is right for you is doing your research. WebMD provides a thorough medical explanation. I encourage you to review their documentation or other reputable sources. In simplified terms; a D&C is a procedure, that occurs in a hospital or surgical center where the fetus and all cells from your uterus are removed using suction. General anesthesia was used in my experience. I was completely asleep during the procedure.

What is a Natural Miscarriage

According to the American Pregnancy Association, a natural miscarriage is defined as the early loss of a pregnancy without intention or medical intervention before 20 weeks gestation. A completely natural miscarriage will not require any medication to start the process and after your body realizes the fetal demise, you will naturally dispel the pregnancy.

A D&C versus Natural Miscarriage

The words “fetal demise” are horrific to hear. We’ve heard them multiple times over the past few years and each time, a knife sinks into my chest. Your physician will walk you through the next step, which is dispelling the pregnancy. Your physician may provide guidance based on your medical history or will ask your preference between a natural miscarriage or a D&C.

I reached out to one of my support groups to get a broader understanding of their choices between a natural miscarriage or a D&C. This section is representative of twenty-two women, who total have experienced 75 miscarriages. Many of the women represented in these findings have experienced both a D&C and natural miscarriages (with and without medication).

Summary Findings from Group Experiences: D&C versus Natural Miscarriage

Out of the woman sampled, 46% of miscarriages either required or selected a D&C, while 54% of miscarriages were a natural experience. The natural miscarriages statistics include natural dispelling without medication and with medication. Comments range from “a D&C is a last resort for me” to “I would get a D&C in the future”. The survey group was also relatively split on personal selection between a D&C and natural experience. Now, that feedback may lead you to more uncertainty than answers. The main takeaway is that this decision is yours. There is no right or wrong answer.

When making a decision between a D&C or natural miscarriage, please ask yourself:

1. Do I want to perform chromosomal testing on the Products of Conception?
   • A D&C allows this to take place at the hospital with analysis typically provided within 2-weeks.
2. What is going on in my life, how much time am I able to dedicate to the process and recovery?
   • A natural miscarriage is a process and will occur without a set timeframe. A D&C will occur on a set date and time.
3. What does your physician recommend based on your medical history?
   • Considerations are early miscarriage, late miscarriage, blighted ovum, or missed miscarriage.
4. How present would you like to be throughout the process?
   • A natural miscarriage will allow you to be present while dispelling the remains of your pregnancy. This can be helpful and provides closure to some, and trauma for others. Pain management for a natural miscarriage will consist of Motrin or other over-the-counter medications.
5. What type of recovery is best for you?
   • With both options, you may experience cramping and bleeding. Based on feedback from the women in my sample group, bleeding and cramping typically last longer with a natural experience. Healthline suggests that the natural miscarriage process can take up to 3-4 weeks or happen quickly. The amount of bleeding and cramping, unless extreme situations are encountered, will not limit normal daily activity.

A D&C Procedure

I am quite familiar with the D&C procedure and keenly aware that the anxiety of not knowing what will happen can be overwhelming. My goal is to prepare you for what will happen on the day of your D&C, even though some experiences may vary. As always, I encourage you to ask your physician to walk through the process with you, step by step to provide additional awareness. This can also help with the decision-making between a natural experience and a D&C.

One aspect to highlight, a nurse will most likely call the day before to confirm the date/time. In preparation for my first D&C, the nurse alerted me of some questions they would ask me prior to the procedure. I am grateful for her because without forwarning it would have increased my sadness.

Prepare yourself for the following pre procedure questions:

• Would you like the hospital chaplain present?
  • Commonly a chaplain is on staff. If you are religious, I encourage you to connect with your Pastor and share a prayer of strength and peace. All of this is completely up to you.
• What would you like to do with the remains?
  • Aside from chromosomal testing, you will need to determine what you would like to do with the remains. The hospital can respectfully dispose of them or you will have the option to use the services of a funeral home or another option of your choice. Think through all of this before arriving.

The D&C procedure timeline:

1. Fast (no food or drink) for 12 hours before the procedure.
2. Arrive at the hospital 90 minutes before the procedure time.
3. Once in your room, you will change into a hospital gown and will be visited by a variety of people. An IV line is started and the Anesthesiologist and surgeon will stop by to review the final questions.
4. You will be rolled back on the gurney to the operating room.
5. The nurses will get you situated in the operating room and the anesthesiologist will start medications.
6. The procedure times will vary. From room to room; estimate 90 minutes.
7. Once you come out of anesthesia, you may feel cramping or an extreme urge to use the washroom.
8. The observation will last an hour. A snack is provided during recovery.
9. At home, plan on resting for the remainder of the day. You will be able to resume relatively normal activity the next day, but make sure you minimize long walks or running until your doctor gives the ok. Cramping, the uterus contracting to transition back to size, can be painful. Motrin will help.

Recovering from a D&C

Recovery from a D&C is full of physical and mental challenges. There are many women out there, just like me, who have gone through recurrent miscarriages. From my conversation with them and my own experience, it does not get easier. The anxiety of “what is going to happen” decreases, but sadness and physical pain are always there.

Physical Recovery

My experience aligns with the feedback received from the group of women surveyed. Physical recovery was relatively easy. Minimal cramping and spotting occurred for less than one week. Motrin is a great option to relieve cramping. Cases have been reported where bleeding lasts a longer period of time, or other complications arise. With any procedure there are risks. Make sure to discuss those with your physician prior to deciding between a D&C versus natural miscarriage. There are risks and possible recovery complications for both.

Emotional Recovery

Emotional recovery is a far longer battle when working through a miscarriage.

• Talk to your partner/spouse. Be open and transparent with how you are feeling. You both experienced the loss.
• Support at the hospital. Prior to leaving the hospital after a D&C procedure, you can ask to see a support professional.
• Seek professional counseling or group support. My local hospital offers a support group for miscarriages and infant loss. Ask your nurse or OB about groups in your area. What to Expect and Facebook also have groups dedicated to miscarriage. I have also found a significant amount of support, guidance, and answers from Facebook groups.
• Focus on the plan. Find a specialist in your area and book an appointment immediately, if you plan on continuing your journey to motherhood. Your specialist will run tests, review results from “products of conception” if you selected that option, and recommend a plan. Ask questions and advocate for yourself if you feel that either the plan is too aggressive or not aggressive enough.
• Surround yourself with strong women. The first few months after miscarriage it is incredibly difficult to interact with individuals who do not understand. I wholeheartedly understand the frustrated feelings when someone says “enjoy the journey” or “your time will come”. I also understand when your neighbor, best friend, and cousin post-pregnancy announcements on social media right after your miscarriage. Those situations can be very difficult. Whether it is through Facebook groups, or by talking to women who have been there, wrap yourself up in their arms. In time, you will find your way back to being that supportive neighbor, friend, and cousin and will look forward to celebrating their bundle of joy with them. In the interim, give yourself some grace.

Much love,

Emily M.