Since Roe v. Wade, the landmark decision that protected a woman's right to choose to have an abortion, was overturned in 2022, there have been many conversations surrounding concerns related to abortion access and what options are still available in the US.
One point that has been brought to light is that abortion access doesn't just affect people who simply don't want to have a child. The overturning of Roe v. Wade, and its former protections, also impacts those needing life-saving procedures to protect themselves if a pregnancy is not viable, like in the case of an ectopic pregnancy.
One such procedure is known as a dilation and curettage, or D&C, which removes tissue from the uterus, in order to treat certain conditions or typically in the case of someone experiencing a miscarriage or terminating a pregnancy.
What Is a D&C?
A D&C is a surgical procedure typically performed under sedation. During the procedure, a provider will use a scraping technique with a surgical tool called a curette to scrape tissue out of the uterus, says Asima Ahmad, MD, a board-certified obstetrician-gynecologist, reproductive endocrinologist and co-founder and chief medical officer of Carrot, a global fertility care platform.
According to Dr. Ahmad, a D&C can be used in the following instances:
- First-trimester pregnancy (for example, for treatment of a miscarriage)
- Management of endometrial polyps, retained placenta, or other uterine abnormalities
- To collect tissue to determine the cause of symptoms such as dysfunctional uterine bleeding
What Happens During a D&C?
According to Mayo Clinic, your doctor may prepare you for a D&C by dilating your cervix a few hours or even a day before the procedure. The purpose of doing this is to help your cervix open gradually to be able to efficiently perform the procedure. Your doctor may do this by prescribing you misoprostol (also known by the brand name Cytotec), which can be taken orally or vaginally to help soften the cervix. Your doctor may also attempt to promote dilation by inserting a thin rod into your cervix, which will expand as it absorbs cervical fluid, which will cause the cervix to open.
Once you're ready for the D&C itself, your provider will have you lie on your back on an exam table with your feet resting in stirrups, similar to a standard gynecological exam. Just like with a Pap test, your provider will insert a speculum into your vagina to be able to see your cervix, followed by several increasingly thick rods to help your cervix slowly dilate until it's open enough for the procedure. They will then remove the dilation rods and insert a spoon-shaped instrument with either a sharp edge or a suction device to remove your uterine tissue. Once again, you will be sedated for this procedure, so you should not feel discomfort during any of these steps.
You'll then spend a few hours in a recovery room to be monitored for heavy bleeding or other complications, as well as to recover from the effects of the anesthesia.
What's the Difference Between a D&C and an Abortion?
A D&C is one method that can be used when someone elects to have an abortion. It is also sometimes needed when someone has a miscarriage, according to Cleveland Clinic. If a miscarriage occurs early in a pregnancy, such as before the 10-week mark, a D&C may not be needed if your body is able to miscarry naturally without leaving leftover tissue in your uterus.
How Many Days Should You Rest After a D&C?
While you should be able to go home within a few hours of having a D&C, you should rest for about a week, according to the Cleveland Clinic — avoiding intense activity and exercise. You should have a follow-up visit with your doctor a week or two after the procedure.
D&C Side Effects
"Fortunately, a D&C is a safe and effective procedure, so its side effects are relatively rare," says Dr. Ahmad. But it's still a surgical procedure, so side effects and complications may include "bleeding, infection, or injury [to your reproductive organs]," says Dr. Ahmad.
Other potential side effects include scarring of the uterine cavity, which can result in the development of Asherman Syndrome (a rare condition in which scar tissue builds up in the uterus) and can cause pain and infertility in some cases, as well as uterine perforation, injury to the vagina, cervix, or other nearby organs such as the bowel, bladder, and blood vessels. But again, side effects are rare.
What Not to Do After a D&C
According to Cleveland Clinic, you should abstain from using tampons and having sex until your doctor clears you to do so. This is to reduce the risk of bacteria entering your vagina and causing an infection. You can also use pads to control any bleeding you may experience.
The Bottom Line
According to Dr. Ahmad, you should talk to your doctor about your options when it comes to dealing with a miscarriage or terminating a pregnancy. Other options include medication to aid in the removal of tissue from the uterus. If you're simply dealing with abnormal uterine bleeding unrelated to pregnancy, a better option may be an endometrial biopsy or a hysteroscopy to be used for evaluation, obtaining a sample of the uterine lining, and diagnosis, says Dr. Ahmad.
"In many cases, a D&C may be the best option, but it is always good to get informed and educated on different options, their risks, and benefits," she says.