Do I Need a D&C? Decision Making and Self Advocacy During a Miscarriage


Some of you are aware of my recent pregnancy loss. Because I had never miscarried until now, I learned a lot in the process and wanted to share my experience in case someone may benefit from the story.

While I think the title serves as a sufficient trigger warning, I will emphasize here that you may not want to read this if you’re struggling emotionally with a completed miscarriage. I got through the incident with relatively little emotional pain, so I worry that my clinical account of the experience may seem flip to those who are grieving a loss of any kind. I’m writing this because I was pressured to go to the hospital for a dilation and curettage procedure, aka a D&C, and I want other women to know how I made the decision to refuse the surgery in case they are in a similar situation. I spent a lot of time doing research online about the procedure and my options in terms of medical interventions and alternatives, so if this post pops up in the future, I hope someone will find it helpful.

There are a lot of resources online that describe what goes on during a miscarriage, but I suspect that none of us care to read up on the topic unless it actually happens to us. And that totally makes sense – what pregnant woman wants to learn all about miscarriage? So we have this phenomenon where this completely normal and common event is not really discussed until it becomes necessary.

The first thing I will tell you is that I have three good friends who have all experienced one or more losses at various stages in their respective pregnancies. Even if you’re pretty independent and confident, I can’t emphasize enough how helpful it is to have someone to talk to who can relate her own experience. You can ask them really personal questions, and it makes a difference coming from someone you know as opposed to a stranger online.

I was about nine and a half weeks pregnant, or so I believed, when I started bleeding somewhat lightly, and then moderately, over the course of a Sunday. It occurred to me right away what might be happening, but it was the weekend and I felt ok so I decided to wait it out. I should tell you here that if you are actually miscarrying, there is nothing you can do to stop the process. Bleeding during pregnancy is always considered abnormal, but the purpose of getting it checked out is to determine whether you are miscarrying or if something else is causing the bleeding. It’s not as if your provider can stop a miscarriage from happening. This is different from taking preventative measures to reduce the risk of a miscarriage. But honestly, the vast majority of miscarriages are caused by factors beyond our control, such as chromosomal abnormalities. That extra cup of coffee you had the other day is pretty unlikely to have impacted your pregnancy, so don’t worry about it or wrack yourself with guilt.

The next day was Monday, and with the increased bleeding came cramping. I made an appointment to see the doctor on call that day. I want to note here that I normally see a certified professional midwife because I give birth at home. Because I had not expected this pregnancy and was facing new medical issues to begin with, I had recently made an appointment to consult with a traditional OB/GYN. This first prenatal visit was supposed to happen at about ten weeks, and I had not had an ultrasound to do the typical seven-week scan that OB/GYN practices like to do. That is actually a really fortunate occurrence, because that seven-week ultrasound would have revealed that the embryo had no heartbeat. My appointment that afternoon, after about a day and a half of steadily increasing bleeding and cramping, told us that the embryo had stopped growing at about the seven-week point, even though the miscarriage itself was only now happening, a little over two weeks later.

There is a lot more I could go into here about this stage in the process, because it was the most emotional for me. This post is already on the longer side, so feel free to comment or get in touch with me if you’d like to hear more about this part of the story or ask any questions. But now I want to focus on the medical stuff. As soon as the ultrasound was over (and it’s a transvaginal ultrasound, which of course is super fun when you’re bleeding and cramping), I snapped into my logical mode and started asking questions. This is just the way I am when things go wrong. I’m not saying it’s the way everyone should be. It would have been completely normal and fine for me to just sit there and cry for a while, and from the look on the ultrasound tech’s face and the softness in her voice (when she told me ‘I’m sorry, I don’t see a heartbeat’), you can tell she expected that.

Instead, I asked what I needed to do next. Next would come a meeting with the OB/GYN, who had seen me just before the ultrasound to let me know the results of my urine testing. And backing up to that pre-ultrasound meeting, the first red flag was when the doctor walked in and said “well, you’re still pregnant!” That was her first mistake. My gut reaction was to take this to mean I was not miscarrying. Perhaps because I had already gone through two pregnancies and was well read on the subject, I quickly realized that what she was saying was that my hCG levels (the pregnancy-indicating hormone) were still elevated. This does not mean the pregnancy is still viable. It just means that the ultrasound is needed to find out what is really going on.

At that point, I left to go eat a taco salad. I’m serious. Whichever receptionist had taken my phone call that morning had somehow neglected to schedule the ultrasound appointment. After my urine test, people were scrambling to find a free ultrasound tech. They ended up telling me to come back in an hour. And I was actually ok with that. After all, I was “still pregnant,” so I went to get a late lunch. Even though I knew what the doctor had really meant, I believed the pregnancy might still be ok.

So when the ultrasound confirmed what I had believed all along to be true, I found myself face to face again with this doctor. If I hadn’t been so weirdly composed, her awful bedside manner would have gotten to me. She wasn’t rude or mean, just really awkward and obviously not great at empathizing with her patients. I didn’t care at that point, because all I wanted to know is whether there was anything I needed to do once I was home waiting for the process to be over. She explained explained to me that I hadn’t passed the embryo and placenta yet (well, I’m inserting those words here, but “it” was the term she used), so she would be sending me to the hospital in the morning for a D&C procedure. A D&C is used to remove the remaining tissue from the uterus when a miscarriage is not completed naturally, or when the baby is no longer developing but the miscarriage process has not begun. Without going into too much detail, as you can find it elsewhere, a D&C is the same procedure used to conduct an abortion.

I started asking questions, because I was a bit familiar with the procedure (but only barely) and I wanted to know how invasive the procedure is, and whether it was medically necessary. I must have asked the same question a different way three or four times: Do I really need the D&C? For whatever reason, the doctor did not want to answer the question. The best I got was “well, it’s been two weeks.”

At that point I was already leaning toward not having the procedure. But I was cramping a lot now, and bleeding profusely, so sure, I wanted it to be over. And then it occurred to me that, like being in labor, the worst pain is when the process is almost over. I asked if it made sense to go in for a D&C the next day when I had already been bleeding for close to two days, and it was apparent that the miscarriage was underway with no complications. Even though I was asking whether the procedure was necessary for me, I got responses that were generalizations. The doctor stated that many women in my situation, who take longer than two weeks to begin miscarrying, want the D&C right away to get the process over with. But that had more to do with women who learn via ultrasound that the pregnancy is no longer viable, and then need to wait for days for the signs of miscarriage. I can absolutely see how emotionally painful that can be, and if I had gone in for that seven-week scan and then had to wonder day after day when I would start to bleed, I think I may have opted for the D&C too.

But here I was, craving ibuprofen and hot tea, just wanting to be home lying down with my cats and my kids. What ended up happening was that the hospital staff couldn’t be reached to schedule the appointment immediately. I was told not to eat or drink anything after midnight that night, and that I would get a call in the morning to let me know when I would have my surgery. Although I was still on the fence at that point, it was hitting me that I would need general anesthesia. I had already begun to make peace with the loss of my pregnancy. I knew that having major surgery within the next 24 hours would likely unravel that sense of peace and my ability to move forward.

So I went home, took a couple ibuprofen, and laid down during the worst of the cramps. That evening, I did more research online, talked to my friends, and called my midwife, who was really knowledgeable about the process. She didn’t tell me not to get the D&C, but she certainly did not make me feel like it was wrong to refuse the surgery if I felt good and was not bleeding profusely (i.e., soaking through more than one pad in an hour). I was now leaning heavily toward not getting the surgery, when the decision was made for me: without getting too explicit (though I would be happy to do so privately), I passed the placenta and knew it was over. The cramping was gone at that point.

At the time, however, I didn’t know that what I was looking at was the placenta. After a freaky moment, I remembered that the tissue I was looking at was too large to be a seven weeks’ gestation embryo. Women who miscarry at home and are further along in their pregnancies are sometimes able to make out the baby and tell it apart from the rest of the tissue. That has to be an incredibly challenging experience, and I have to say that I’m glad I didn’t need to go through that. However, from the accounts I read online, many women who have this experience describe it as amazing and awe inspiring, however sad and a bit strange it may seem to others. It also helps some women make peace with the loss. For those who would prefer the D&C to lend a more clinical feel to the process and not need to see the miscarriage happening, I can understand how this experience would be most unpleasant. It’s just a personal choice and there is no right or wrong way to feel about your own pregnancy loss and what you need to do to get through it.

When the nurse called the next day to tell me my surgery was scheduled, I explained that it would not be necessary since the miscarriage was now completed. My ultrasound a week later confirmed that my uterus was empty. Sometimes pregnancy tissue remains after a miscarriage is thought to be complete, and that can be dangerous so you definitely need the follow-up afterward if you feel cramping or ill in any way. I was relieved that everything was over. I saw a different doctor this time, who was very sweet and told me to wait two cycles if I was going to try to conceive again.

I wrote this because I can’t imagine what would have happened if I had gone along with the surgery without asking any questions and understanding that I did have options. Although in a sense I got my wish – finishing the miscarriage myself at home before there was even time to go in for surgery – I like to think that I would have felt confident enough to decline the surgery that morning if I was feeling well and letting the process happen naturally. Fortunately, this had been my third pregnancy, and I was very familiar with what’s normal and not normal for pregnancy, what labor and delivery feels like, and how to advocate for myself when faced with health and medical decisions. Those factors are not always present, and I want women and their partners to know that those advocacy skills may come into play at times other than during labor and delivery.

image credit: Bad Muskau (Creative Commons Attribution-ShareAlike 3.0 Unported license)

3 thoughts on “Do I Need a D&C? Decision Making and Self Advocacy During a Miscarriage

  1. Melanie, thank you so much for your authentic and raw honesty. As Emily said, this sort of thing really needs to be talked about, as it happens to so many women. I’m sorry you had to go through this, but appreciate the sharing of your experience. Inspired by you, I feel like I want to share a bit about my first pregnancy that ended in miscarriage ~ at a 12 week ultrasound it was discovered that my baby had stopped growing at 8 weeks. So for four weeks, I’d been been pregnant but not really. I was devastated. Thankfully, I had a wonderful midwife at the time who talked me through this. I knew Id didn’t want a hospital procedure. Like you, I’d been planning a homebirth and figured that if I couldn’t handle a natural miscarriage, how could I handle a natural birth? So I waited to miscarry. But I never did. Something happened to me that you really never hear about, my body absorbed the baby back into my body. The only way to tell that the baby wasn’t there anymore was to monitor my hcg levels. When it was zero, I knew the baby was gone. This took another four weeks. (This was so unheard of my midwife wrote a paper about it.) It was a sad, heart-breaking yet beautiful time. I felt such strength and wonder while being in the depths of the grieving process. It’s a time where I learned what I was really made of. As much as I hate suffering as part of the human experience, pain really does help us evolve and grow. I see your beauty, strength, and wisdom shining through this post, Sister. I’m very moved. Thank you for sharing it with us. ♥

  2. This is the type of story that I don’t think is shared often enough in a public forum. I’m so sorry you had to go through this, but I think by writing about it you’ve helped a lot of women!

  3. This is a great post, Melanie. I’m so heartbroken for you, because I lost an early pregnancy awhile back, and it was so sad– much sadder than I’d anticipated. I’m glad you didn’t also have to go through the awful D&C. I’d imagine the pain and stress of surgery would have probably made things worse, at least in this specific scenario. I hope you’re doing okay now.

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