Everything You Need to Know About Getting a D&C

Fact: Roughly 10 percent of clinically recognized pregnancies end in miscarriage. And although women's bodies should expel pregnancy tissue on their own through bleeding, sometimes not all of it is removed, or at least, not fast enough — which is where dilation and curettage (D&C) comes in. Also notable is that about one in four women will have an abortion in her lifetime, according to research conducted by the Guttmacher Institute. Some of those abortions are carried out by taking pills in what's known as a medication abortion while others involve a D&C.

"It's normal to have pregnancy loss. It happens to many people, and we don't talk about it, but we should," says Dr. Diane Horvath. "There's no shame in pregnancy loss, just like there's no shame in getting an abortion." Yet the silence and judgment surrounding abortion and miscarriage can keep women from knowing what to expect during the procedure. Even more disconcerting is the Supreme Court's decision to overturn Roe vs. Wade, limiting women's access to receiving a safe and legal abortion.

So to help you separate fact from political discourse and learn more about a D&C, including what having the medical procedure post-miscarriage or as an abortion actually entails, keep reading.

What is a D&C?

Dilation and curettage, the procedure in which the cervix is opened so that tissue can be removed from the inside of the uterus, is performed at doctor's offices, surgical centers, and hospitals both to remove pregnancy tissue and diagnose uterine conditions, such as abnormal bleeding. Whether the procedure is performed after a miscarriage or as an abortion, "it is the same," says Dr. Horvath.

A speculum is placed inside the vagina, just like before a pap smear. Dr. Horvath explains that the cervix is opened a small amount, about the diameter of a pen in early pregnancy (up to 14 weeks), and tissue lining the uterus is removed. Typically, this is done with a straw-like tube using suction, which is why it's sometimes called a dilation and aspiration, or D&A. The process takes between three and five minutes and involves different pain medication or sedation levels depending on a patient's preference and where it is performed. Most patients go home to rest afterward with some cramping, bleeding, and period-level pain medication; others go about their day.

D&C Recovery

When performed by medical professionals, D&Cs are safe and effective. Mild pain and light spotting after a D&C are normal, and recovery typically takes one or two days. (Complications are rare, but heavy bleeding, fever, abdominal pain, or abnormal discharge are all reasons to call your doctor, and you should ask when it's safe to use tampons or have sex afterward).

But political rhetoric around terminating a pregnancy has led to "this false idea that abortion procedures are especially dangerous or deregulated in ways that other procedures are not," Dr. Horvath says. Often, that makes patients fearful of undergoing a D&C, even though it is "really one of the safest, most straightforward procedures you can have in an office setting," she adds.

It's also important to note that undergoing a safe, legal abortion won't harm your future fertility. "Some people who have had abortions and then experience pregnancy loss might emotionally connect the two, but they are not medically connected," says Dr. Alexandra Sacks. "The fear that they're related is fear and is not scientifically true."

Dr. Horvath adds that the political fight over abortion has created an "artificial division" between women whose wanted pregnancies end and those whose unwanted pregnancies end. First of all, the medical procedure is identical in both cases; and then there's the fact that many times the same woman will undergo it for both reasons throughout her lifetime.

"There are all sorts of reasons why a pregnancy would end," Dr. Sacks says, but "the same thing needs to happen: You need to clean and clear the uterus so you can get back to your healthy baseline, without discomfort or pain or infection."

Women can feel different emotions around the experience, but at the end of the day, it's about healthcare, not politics. And a major study showed that an overwhelming majority of women feel confident in their choices around abortion: 99 percent of women who had terminated pregnancies still felt abortion had been the right decision five years later.

"There's not one kind of person who has an abortion, and one kind of person who has a miscarriage and needs a D&C, and one kind of person who has a baby. That's the same person at different points in their life," Dr. Horvath says. "Plenty of people who have had a miscarriage may go on later to have a healthy pregnancy, carry to term and have a delivery, and then may go on to have an abortion after that, or vice versa. This is the same person experiencing these things at different life stages."

D&C After Miscarriage

When Alison* became pregnant in 2019, she was elated. But when she went in for her seven-week appointment, "there was no yolk sac, no heartbeat, no growth. The pregnancy wasn't viable," she says. "I knew my options were to either miscarry naturally — which could begin in days or weeks, take days or weeks, and could still mean I'd need to have a D&C — or have the D&C." That's because even if a pregnancy is no longer viable, pregnancy symptoms can continue. For many women, nausea, swollen breasts, exhaustion, and a surge of hormones make coping with the emotions around a miscarriage even harder. Alison chose to have the procedure. "I didn't want to feel or look pregnant if I wasn't, and I wanted to have more control over the process."

Alison brought her husband along, texted friends from the waiting room, and even shared her miscarriage story on a Facebook group of 7,000 local moms. Her D&C was performed at about eight weeks gestation. "Right before anesthesia was administered, my doctor patted and squeezed my hand," Alison recounts. "I felt her compassion for my wish to become a family of four not coming true."

D&C as an Abortion

At first, Marcy*, 30, worried even friends and family wouldn't understand her decision to end the pregnancy she had wanted so badly. The New York City-based media professional was 12 weeks pregnant for the first time in April 2018 when she went to her ob-gyn for a nuchal scan, a routine ultrasound to detect fetal abnormalities.

After a few heart-wrenching days, Marcy says she was diagnosed with trisomy 18, a chromosomal abnormality that prevents the heart and other organs from developing properly and causes many fetuses to die in utero or shortly after being born. Often they are miscarried.

The thought of waking up and wondering if each day would be the day she would lose her pregnancy was too much to bear. "I knew I wouldn't be able to start moving on until it was complete," Marcy says, and she scheduled a D&C.

She was unconscious for the procedure and woke up surprised at how simple it had been. The feelings that came after were less simple. "I remember feeling completely empty. It was as if I had been whole; now, I was only a fraction of what I had been before. But I also felt relief," Marcy says. "I knew in my heart that as hard as it had been, we made the right decision for us. I was relieved not to have to spend every day wondering if today [was] the day I would lose the baby. I was relieved to know that I had spared our baby the pain of a life he or she could never really live. I was relieved that all the worrying, questioning, and debating was over."

Marcy and her husband told their immediate families and closest friends, who were supportive. But it took her a lot longer to tell people outside her innermost circle. "There's still a lot of stigmas attached to the process of ending a pregnancy, no matter what the reason," she says, and she feared how people would react. However, she also felt "immense gratitude," both for her doctor, who had given her the information she needed without judgment, and for the staff at the facility who treated her with kindness and respect.

"I was 13 weeks pregnant when I went through this, and there are many places where this would not have been legal," Marcy says. "I can say with certainty that the emotional trauma I would have gone through had I been forced to carry the baby to term would have been completely devastating."

Final Thoughts

It's so crucial that abortion care, including D&Cs, remain accessible. "If the idea of having a miscarriage at home is traumatizing for someone, then I want to be able to offer them a few-minute procedure in my office with sedation medication so that they can be done with that episode of their life," says Dr. Horvath.

Fifty-eight percent of women of reproductive age in the U.S. (nearly 40 million women) live in states that were considered hostile to abortion rights in 2019, according to the Guttmacher Institute, and the disparities in access between urban and rural areas and coastal and midwestern regions have grown.

With reproductive healthcare at risk, Alison, too, finds herself thinking about what life would have been like if she hadn't been able to make that choice. "My doctor helped change the course of my life, and not everyone is as lucky to have control over their life," she says. "This shouldn't even be about politics." Indeed, Dr. Horvath explains, it's about healthcare. "When we don't have access to abortion care, we also reduce access to treatment for pregnancy loss."

*Names have been changed at the subjects' request.