The D & C

The morning after learning that my baby's heart had stopped, I knew I needed one more thing before the D & C (Dilation & Curettage): reassurance that my baby was really and truly dead. I called the OBGYN's office and asked, as nicely as I could, that while I knew it was "not logical," I needed "another ultrasound" before they did this irreversible procedure. Otherwise, there would always be the tiniest bit of doubt in my mind that maybe, just maybe, they had made a mistake. At first I was told that the ultrasound schedule was full. So I hung up and immediately made an appointment with a private company that specializes in doing 2D/3D images of (living) babies. I knew my request was odd and that if I hinted at the idea that they were somehow giving me a second opinion, they would probably deny me the scan. So I simply said I wanted some memorial ultrasound pictures of the baby I was miscarrying. They agreed to do it.

I arrived and realized how truly odd this was: it was a room with a large couch and places for a crowd to watch the baby on a big movie screen as the tech performed the ultrasound...obviously a moment of great celebration and fun under normal circumstances. I felt so strange and sad lying there by myself. But the tech did the scan and as the little baby bean's image was projected on to the big screen, it really sunk in that the heart was not beating. I asked her a lot of questions which helped me understand what I was seeing on the screen. I left that place ready to move on, so I don't regret it. (Surprisingly, the one picture I took home from the OB's office was detailed enough that we could see the head, face, body, limbs, and even the eyes and mouth of our little one...even at just 8 weeks.)

I called and scheduled the D & C for later that morning with my OB. My husband went with me and they even did a repeat scan just before the procedure, which was very compassionate of them since they were on a full schedule.

The term "D & C" is most frequently used in reference to the process of emptying the uterus after a miscarriage, but in the first trimester, what is almost always performed is actually a "Vacuum Aspiration." This is a much less risky procedure: often the cervix does not require dilation and no metal curettage is used. The process I experienced was this:

• The OB explained the entire process to me and my husband. He was then excused.
• The OB and nurse gave me a sedative through an IV. (I actually felt like I was very drunk and tired from it immediately.)
• They cleaned/sanitized the exterior of the cervix and inserted local anesthesia into the uterus (this hurt a bit), but the sedative kept me calm. I remember saying, "Ouch!" though.
• They then inserted a small tube into the cervix.
• When they turned on the machine it sounded like a loud vacuum and it aspirates (suctions) out the contents of the uterus in waves, which I found really rather painful. I gripped the table and did not open my eyes; I didn't want to see anything.
• It was over very quickly: just a few minutes of this and the machine was off. They made sure I was okay and then let me recover alone.
• My OB found my husband a little later and brought him back to my room. He had picked up 2 prescriptions: a strong antibiotic to prevent infection and a pill to help my uterus contract in case of heavy bleeding (with pitocin in it).
• The OB gave me some Advil and told me to continue to take it for any pain. I recovered for about half an hour and was told I could go home.

I was grateful that I didn't have general anesthesia because that makes me very nauseated and the sedative left me feeling very sleepy and calm instead. My husband escorted me out of the office once again through the sea of pregnant women and back to the car. We stopped for some noodle soup to go and went home. I spent the rest of the day in bed and my dear cat and dog cuddled up alongside me, as if they knew something was wrong and wanted to comfort me.

The bleeding was light and didn't last long. I had spotting off and on for a few days but over all my physical state was much better than expected. It was easier physically to deal with the D & C than the natural miscarriage which was traumatic because it is so sadly visceral. I cried a lot that week and just tried to be gentle with myself. There was a terrible feeling of emptiness though: I had been "two" and now I was just "one" again. I would reach for my tummy and have to re-remember that no little one was in there. We waited to hear back from the OB about the lab results on the baby. One advantage to a D & C over a natural miscarriage is that they can test the tissue and let you know what happened, if anything. Apparently they discover something about 50% of the time. Most miscarriages are mysteries as to "why" they happened however.