Most women experience zero complications during pregnancy and they go on to deliver and raise healthy babies. But for some women, things don’t go as expected and they may have to end their pregnancies. It can be heartbreaking for a couple to make the difficult decision of ending their pregnancy or it may result in a miscarriage.
If a woman’s pregnancy needs to be terminated within the first thirteen weeks, a procedure called Dilation and Curettage is performed. However, if the pregnancy is further along then, Dilation and Evacuation (D&E) will be performed.
What Is Dilation and Evacuation?
Dilation and evacuation is a medical procedure that is performed in the second trimester of pregnancy to remove the remains of a foetus from the uterus. It combines dilation, vacuum aspiration and curettage. During D&E, forceps are used to aid in removing the remains of the foetus. While a D&E is usually done before the 15th week of pregnancy is reached, women can also have a D&E at 20 weeks.
When Is D&E Abortion Done?
Women who need to end their pregnancies from the 13th week onwards can undergo the D&E procedure of abortion.
To Whom D&E Is Recommended?
There are various reasons why a woman may need to undergo a D&E procedure. A woman may be recommended D & E in the following cases:
- When the baby dies in the womb. The baby will bestillborn, and the woman will be advised to have its remains removed as it can sometimes lead to an infection.
- If the baby is detected with extremely serious abnormalities, an abortion will be suggested.
- If there is a premature rupture of the membranes, an immediate termination of the pregnancy may be prescribed.
- In some cases, the woman’s health may be seriously compromised if she continues with the pregnancy. In such cases, she may be advised to terminate the pregnancy.
Dilation and Evacuation Procedure Steps
Having to make the decision to terminate a pregnancy is very difficult for expecting couples. It can be very frightening for a woman to undergo such an experience and not knowing what to expect can be helpful. Here is what to expect from D&E procedures:
Step 1: During the Surgery
- Dilators for abortion at this stage is necessary. The cervixis prepared around one or two days before the actual procedure is to be performed. This often requires the use of either seaweed or hydrogel rods. These absorb the moisture from the cervix, and then expand it.
- Another method that can be used to expand the cervix is through medication, but this is not preferred unless it is earlier in the 13th week.
- Antibiotics are administered to prevent infection. General anaesthesiais administered before anything is done.
- Once the anaesthesia has set in, the foetus and the placentaare removed from the uterus through the use of suctioning, curettage and forceps.
Step 2: After the Surgery
- You will need to rest to allow your body to heal properly.
- You will be put on antibiotics and other medications that help with shrinkingof the uterus.
- Spotting or bleeding for two weeks after the procedure is normal. Use pads for this and avoid anything that needs to be inserted into the vagina. This is all to prevent Abstain from sex at this time.
- Cramping is to be expected. The uterus will be shrinking back to its original size. This cramping may last for a few days, or it could be only for several hours. It depends on the individual.
Risks And Complications
While most procedures go off without a hitch, there are some occasions when you might face a few complications that will require serious medical attention.
Risks Associated With D&E Surgery
Here are some of the risks that are associated with D&E procedure:
- Injury can be caused in the lining of the uterus or the cervix.
- Although rare, a hole can form in the lining of the uterus. This is called a uterine perforation. Itusually forms during the dilation stage.
- The uterus may not contract back into its non-pregnant size
- Tissue can sometimes remain in the uterus.
Complications That Can Occur Later
Sometimes complications associated with after the D&E procedure can arise at a later date. These complications include:
- If you have developed a body infection as a result, you may experience muscle aches, headaches and dizziness. You could also go through a general feeling of unease or illness. Not all infections result in a fever as a symptom.
- Severe bleeding, different from your regular menstrual bleeding, can occur. This bleeding can be excessive and you may have to go through at least two large pads in an hour or less.
- Fever or hot flashes that last for over four hours.
- Swelling of the abdomen.
- Vomiting that continues for over four hours.
- Increased heart rate.
- Swelling, pain or redness occurring in or around the genitals.
- Increased vaginal discharge or discharge with a bad odour.
D&E Abortion – Cost
Dilation and evacuation abortion is an expensive procedure and can cost from around $500 to $3000 or sometimes, much more.
Taking Care After Undergoing a D&E Procedure
Having an abortion so late in the pregnancy can be very difficult for a woman. But if it is inevitable, you will have to go through it. There are a few things you should keep in mind to take care of yourself after undergoing a D&E procedure for your speedy recovery:
- Remember that as you have just gone through a very difficult procedure related to your reproduction, you will need to abstain from having sexual intercourse until your doctor says it is alright. Even when you get a go ahead from your doctor, it is advisable that you ask your spouse to usea condom to lower the chances of infections. Birth control is another thing you will need to consider. Getting pregnant again so soon will not allow your body to heal as well as it should after going through something so traumatizing.
- For those who have had to undergo a D&E procedure, it is best they visit a counsellorif they are unable to recover emotionally. You can even visit your therapist if you already have one. It is very important to speak to a professional as there could be many factors that can lead to depression.Depression can also be a result of the changes in pregnancy hormones. Some of the most notable symptoms of depression are a change in your appetite or sleep, fatigue, constant sorrow, anxiety, emptiness and irritability. If these persist for more than two weeks, you should definitely seek counselling.
- After the procedure, you will be kept underobservation for about an hour or so. Once the observation period is over, your nurse will give you all the instructions you need to follow to recover soon physically.
Whether you undergo a D&E procedure due to a complication or a miscarriage, it can take a toll on your health. Your physical and mental health will suffer but it is important that you speak to your doctor and open up with your loved ones to heal completely.
Don’t keep your feelings bottled up. Speak to your gynaecologist what you can do for a speedy recovery. Remember, undergoing a D&E procedure does not mean that you won’t be able to have a baby again. The D&E procedure does not have affect a woman’s fertility. So give yourself enough time to heal; once you’re ready to have a baby, you can always try for another child if there are no health risks!