Many first trimester pregnancies end in miscarriage, that is anywhere from 10-25% of early pregnancies. While miscarriage can be heart wrenching, it is often the body recognizing that the pregnancy may have not been as healthy as it should be. Part of preparing for pregnancy is educating yourself of the possibility of miscarriage. Being informed about miscarriage will help you to make smart decisions about your health.
Most times the body will naturally miscarry on its own, but sometimes a miscarriage may be incomplete or missed. In the case of incomplete or missed miscarriage your doctor will probably suggest a D&C procedure. D&C stands for dilation and curettage. D&C is a surgical procedure that dilates the cervix and curettage is performed by scraping and suctioning the uterine contents.
In the unfortunate event you are experiencing a miscarriage and notice that you have not expelled any tissues along with the regular bleeding, it would be best to see your doctor. Sometimes the body does not expel the fetal tissue, placenta or other tissue completely, or at all. In these cases there is a higher risk of infection and/or hemorrhage. D&C is the most common procedure to reduce the risk of infection and/or hemorrhage.
Is D&C Procedure Necessary After Miscarriage?
Most women’s bodies are perfectly capable of miscarrying naturally on their own. The earlier in the pregnancy a miscarriage happens, the greater chance it will complete on its own. After 10 weeks gestation, it is more likely to be incomplete or missed.
With most cases of complete miscarriage, blood, fetal and placental tissues are expelled rather quickly, over the course of a couple days to a week. Bleeding and cramping should be over in a few days.
With incomplete miscarriage, your doctor will likely suggest D&C, but may be willing to monitor your situation to see if your body will naturally pass the retained tissue on its own.
Women with missed miscarriage will more than likely be given a D&C to prevent infection.
Some doctors may be willing to prescribe the drug misoprostol (Cytotec) to dilate the cervix and cause uterine contractions to aid the body in miscarriage. This drug comes with its own risks and may not be approved for use in some countries. Please speak with your doctor about its use as an alternative to D&C.
Signs of Incomplete and Missed Miscarriage:
- Vaginal bleeding
- No fetal heart tones
- Cramping (contractions), rhythmic, labor-like, but milder
- Cervical dilation
- Some passing of clots and tissues
- If cramping and bleeding persists for more than a couple weeks this may be a sign of retained tissues, contact your doctor
- No sign of bleeding or just some spotting
- No passing of tissue
- No fetal heart tones
- Miscarriage is imminent, but has not come on yet
- This may persist for several weeks and miscarriage should come on its own
- If no bleeding with passing of tissue has taken place by 4 weeks the risk of infection becomes great, medical attention is necessary right away
Possible Risks and Complications of D&C
- Negative reaction to anesthesia or medication given for procedure
- Hemorrhage or heavy bleeding
- Infection to uterus, fallopian tubes, ovaries
- Puncture of the uterus
- Incomplete procedure, requiring another D&C to be performed
- Scarring of the uterus and/or cervix, also known as Asherman’s syndrome
A Note About Asherman’s Syndrome
According to the International Asherman’s Association 90% of Asherman’s cases are due to D&C. Women who have had a D&C 2-4 weeks post-delivery, due to retained placental reminants have up to a 25% risk of developing Asherman’s. D&C performed for missed miscarriage have a 30.9% chance of developing Asherman’s, whereas women who have had a D&C due to an incomplete miscarriage only have a 6.4% chance of developing Asherman’s. Women who have had more than 2 D&C’s have an increased chance of developing Asherman’s by 32%.
Study Shows Repeated D&C Increases Risk of Developing Asherman’s Syndrome
A study, published in Human Reproduction, evaluated 50 women ages 19-44, through hysteroscopy, to determine the presence of uterine adhesions after a required second D&C due to either remaining placental remnants following delivery, missed miscarriage or medical abortion. Of the 50 women, 20 (40%) had developed intrauterine adhesions. Of that 40%, 75% had developed grade II-IV, grade IV being the most severe.
To reduce the incidence of scar tissue and adhesion formation we suggest allowing your body to miscarry naturally on its own. If at anytime during miscarriage it is apparent that you may be experiencing an incomplete miscarriage, contact your doctor to discuss your options. Some naturopathic doctors or clinical herbalists and may be able to suggest an herbal regimen to help the body pass an incomplete miscarriage.
Natural Therapies to Prepare for D&C
During D&C the cervix is dilated with narrow instruments and then a speculum to keep the cervix opened is inserted. Then a surgical instrument is inserted through the cervical opening into the uterine cavity. This can cause soreness and cramping of the cervical and uterine tissues. Because the vagina and uterus are exposed to instruments and are exposed to other foreign objects, air, ect., there is a slight risk of infection. Usually a patient is given antibiotics to reduce the incidence of infection. Painkillers and anti-inflammatory drugs are also typically given to reduce pain and swelling.
What can you do from home prior to D&C to speed up recovery?
- Garlic (Allium sativum)
Garlic taken internally may greatly help prevent infection. Garlic is a natural antibiotic, but is safe to take with antibiotic medications. Eat one to two cloves of raw garlic daily. If you cannot stomach the taste, crush the clove of garlic, add to a bit of honey and take a spoonful.
The vaginal flora may be compromised due to the invasive nature of this procedure. Be sure to take a good probiotic that contains lactobacillus. This will help restore and protect vaginal flora, reducing the incidence of yeast infection.
Echinacea (Echinacea spp.) and Goldenseal Rt. (Hydrastis canadensis)
Echinacea and Goldenseal may help to stimulate the immune system to fight off both bacterial and viral infections. When taken for a week it may support the body in preventing any infection that may occur from D&C. It is best taken internally as a tincture or capsule just before, during and for up to a week after the procedure. An Echinacea/Goldenseal liquid extract taken every 3 hours for the first two days after surgery may greatly help to reduce infection. This extract blend may be continued on 3 times a day, for a week for continued infection prevention. This is safe to take with antibiotics.
Homeopathic Arnica montana 30c
This homeopathic remedy is specific for recovery for bruising, sore muscles and tissues, bleeding. This remedy also helps to manage trauma and fear. It is best begun the morning of the procedure and continued for 2-3 days afterward to aid in recovery. Follow directions on product label.
*All of the above can be found at your local health food store.
Cramp bark (Viburnum opulus) or Black haw (Viburnum prunifolium)
Cramp bark and Black haw are considered among the most important herbs to soothe painful uterine cramps. You are likely to experiencing cramping prior to, during and after the procedure. These herbs help to prevent the uterus from spasming and cramping up, which can make pain worse. Both have have a mild sedative action, aiding the body in reducing anxiety, nervous tension, and irritability, while promoting a sense of calm and well being. These are also part of our UteriCalm herbal formula, which could be used for D&C preparation and recovery.
The Recovery Wellness Kit
The Recovery Wellness Kit is designed to comfort, ease and aid a woman’s body, mind and soul in the recovery process post-pregnancy loss. This kit combines key herbs and the highest quality therapeutic essential oils to support you through this recovery time.
Natural Therapies for Restoring Reproductive Health After D&C
The goal here is to support the uterus, continue to work to prevent infection and prevent scar tissue and adhesion formation. D&C procedure can be a difficult experience to go through. Processing what you have been through self nurturing or stress relieving techniques may also be helpful in recovery.
Note: Do not begin any of these until bleeding has stopped.
Systemic Enzyme Therapy
Systemic Enzyme Therapy uses a systemic enzyme blend to help prevent scar tissue formation, reduce inflammation and pain. Consider having a systemic enzyme blend on hand for post-procedure healing. Beginning systemic enzymes after bleeding has stopped, after D&C, may help to prevent scar tissue from forming. Prevention of scar tissue will help to prevent Asherman’s syndrome and blocked fallopian tubes.
Self Fertility Massage
Self Fertility Massage is one of the easiest and most cost effective ways to improve uterine health, break-up and prevent adhesion formation, and promote healing of the uterus. Plus it can be done from the comfort and privacy of your own home. Not only can you do both Self Fertility Massage and Castor Oil packs prior to any surgical procedure to improve uterine health, you can do it after those procedures to prevent adhesion formation.
Castor Oil Pack
A Castor Oil Pack is a cloth soaked in castor oil, which is placed on the skin to enhance circulation, and promote healing of the tissues and organs underneath the skin. This therapy is complementary to Self Fertility Massage.
* Increases breakdown and removal of scar tissue build-up via the lymphatic system.
* Increases circulation, brings in fresh healthy blood.
* Promote new healthy tissue growth.
* Aids the body of cleansing out old, dead, toxic, or damaged tissues.
Castor oil packs are best used 4-6 times a week. A good healing plan with these packs are 4 days on, 4 days off, for several months. Do not begin this until you feel your uterus is healed.
Women’s Best Friend
This herbal blend may help fight infection and balance hormones after miscarriage loss. Women’s Best Friend works to reduce pain and swelling, is extremely antibiotic, antimicrobial and anti-inflammatory. It works to heal any infection in the reproductive system, while also reducing pain and inflammation from foreign tissue growth. Reduction in inflammation may help to prevent scar tissue and adhesion. Some herbs in this blend are tonifying for the uterus, aiding in strengthening the uterine muscles and tissues. There are 6 key herbs in this blend that support hormonal balance and 2 that are rich in iron to help restore adequate levels due to blood loss.
It takes the body time to recover from miscarriage and to “reset” the hormonal feedback loop. The combination of the above therapies may greatly aid the body in recovery from miscarriage and D&C.
1. Romm, Aviva. Botanical Medicine for Women’s Health. Churchill Livingstone, 2010
5. Hum. Reprod. (1998) 13 (12): 3347-3350.
6. Reproductive BioMedicine Online, (2011) Volume 23, Issue 1: 63-76.