A Holistic Approach to a Dilation and Curettage (D and C)
What is a D and C?
A D and C (dilate and curettage) is a surgical procedure that is sometimes needed after a miscarriage. It can also be performed to remove polyps or tumors from the uterus. Oftentimes it is done in the operating room, but can also be done in a doctors office.
During surgery, an OB/GYN dilates (opens) the cervix to be able access the uterus. They use a curettage to remove anything that might remain in the uterus. This could be placental or fetal tissue. Sometimes, hysteroscopy is utilized by inserting a small, thin camera into the uterus to better visualize the area. A D and C can also be used to diagnose other uterine problems.
Why is a D and C needed after miscarriage?
Usually, women are able to miscarry on their own naturally and the body is able to pass their fetus without a problem. In some circumstances, tissues are retained in the uterus. This can make a woman highly susceptible to infection along with preventing another pregnancy and disrupting hormone function. Retained tissue should be dealt with swiftly to ensure proper recovery from miscarriage.
What are the risks involved in a D and C?
While significant risks and complications with a D and C are rare, sometimes they do occur. These include:
Perforation of the uterus
Damage to the cervix
Reactions to anesthesia
Heavy bleeding
Scar tissue development in the uterus, known as Asherman’s syndrome
Infection
How to Prepare Your Body for a D and C?
Oftentimes, D and Cs happen directly after a miscarriage. The procedure is usually scheduled relatively soon after the loss and there is not a lot of time for extended preparation. Focusing on a nutrient dense, non-inflammatory diet is crucial. I recommend drinking collagen-rich bone broth to provide essential, easily assimilated nutrition for the body.
Probiotics: Because a D and C is pretty invasive surgery, the vaginal microbiota can be compromised. Consider taking a therapeutic soil or spore-based probiotic to restore and protect the flora in the vaginal and pelvic area. Fermented food such as sauerkraut and kimchi also offer beneficial microbes. Consuming probiotics will strengthen the immune system and the flora in the genital region to avoid yeast infections or other infections from the procedure.
Day of Surgery
There are a few things to keep in mind on the day of a D and C procedure. Depending on what your doctor tells you, you will likely need to abstain from food for a period of time before surgery. If you are able, consume beverages that are high in electrolytes such as coconut water and bone broth.
Keeping yourself grounded is vitally important. While the conventional medical system offers many wonderful, life-saving treatments to our modern lives, it is important to remember that surgery is a significant medical intervention. Taking time for gratitude and prayer or meditation will help to foster emotional wellbeing as you enter into the procedure. If possible, walk barefoot on the grass to bolster yourself with grounding energy before arriving at the hospital.
Recovery
Most of the time, recovery is fairly smooth after a D and C. For the first couple weeks after a D and C, you should prioritize rest and recovery. You will likely feel tired after surgery, so listen to your body and rest as needed. Furthermore, sexual intercourse should be avoided along with anything else being inserted into the vagina such as tampons or menstrual cups. Light bleeding and spotting should be expected, so have quality, organic pads and pantyliners on hand. Bleeding should subside within two weeks.
Diet
Consuming a nutrient dense, non-inflammatory diet is crucial when recovering from surgery to manage inflammation and provide the necessary nutrients for the body to restore. Focus on quality fats, proteins, fiber, fruits, and vegetables.
Continue to take probiotics and eat fermented foods to nourish the vaginal microbiota.
Sipping on red raspberry and stinging nettle tea or bone broth can help rebuild the body. Stinging nettle and red raspberry tea help tone the uterus and provide necessary nutrients to nourish the body and uterus. Bone broth is particularly healing due to its rich amino acid profile to calm inflammation and support tissue recovery.
If you lost a lot of blood due to miscarriage or surgery, rebuilding the blood is primary importance. Iron-rich foods such as grass-fed and pasture-raised meats, liver, free range egg yolks, figs, dates, dark leafy greens, and blackstrap molasses can help to restore iron levels in the blood.
Folate
Folate is a crucial vitamin for after a miscarriage and surgery. It is also important if you hope to pursue a healthy pregnancy. It promotes egg quality, methylation, normal follicle degradation, corpus luteal degradation, normal endometrial shedding, fertilization, embryo development, and implantation
Essential Fatty Acids
DHA and EPA are required for the developing baby, especially for the development of the brain. Be sure to augment essential fatty acids status by eating wild caught oily fish, avocados, coconut oil, flaxseed, chia seeds, and walnuts.
Additionally, many turn to quality fish oils to calm inflammation after surgery. In fact, fish oils have been shown to reduce inflammatory cytokines and modulate the immune system postoperatively.
Anti Inflammatories
Anti-inflammatory compounds such as curcumin and resveratrol help to calm inflammation within the body. Reducing inflammation may help to prevent scar tissue and adhesion after surgery. Not only that, these compounds help bolster the immune system.
Vitamin C
The body needs vitamin C to make collagen needed for skin, blood vessels, bones, muscles, tendons, ligaments, teeth, and hair. It is helpful for your body to rebuild after surgery. Not only that, vitamin C is a potent antioxidant which helps the body clear free radicals that can accumulate due to surgery. Taking 1,000 mg twice a day leading up to surgery and after can help speed recovery.
Arnica Montana
If you experience significant cramping, the homeopathic remedy Arnica Montana can help ease pain. Use a 30c potency for the first 48 hours after surgery. Take 4 to 5 tablets every two to four hours.
Two Weeks After Surgery
After two weeks or you have been cleared by your doctor, there are some other strategies to promote healing to the reproductive system.
Castor Oil Packs
Utilizing castor oil packs therapeutically after a D and C can help optimize uterine function. In fact, castor oil packs have been used for centuries to promote wellness within the body, especially within the reproductive system.
Soak a piece of organic cotton flannel with a few tablespoons of castor oil and place it over the uterus. Use a hot water bottle or heating pad over the fabric. Sometimes it is nice to have another layer of cloth of a piece of unbleached wax paper to protect the heating device from castor oil.
As the caster oil is absorbed into the skin, it enhances circulation to the area and promotes healing of the uterus (and any other gland or organ beneath). When performed specifically for fertility, castor oil packs can promote the health of the uterus, ovaries, fallopian tubes. They also foster detoxification and egg quality. Castor oils packs are done in 60 to 90 minute increments up to 4 times a week.
Fertility Massage
Fertility massage is a non-invasive therapy designed to bring the organs within the abdominal area back into alignment, releasing pressure and strengthening the surrounding muscles and ligaments. Similar to castor oil packs, fertility massage can increase circulation to the reproductive organs and therefore optimize their function. Not only can this form of deep, yet gentle massage support fertility, it can also be used to regulate menstrual cycles.
You can learn how to perform a self massage to promote optimal fertility. Furthermore, there are various therapists that do womb and fertility massage.
Symptoms of Concern After a D & C
Typically, your doctor will want to see you within two weeks of having a D and C. While fatigue and light bleeding and spotting are normal after this procedure, there are symptoms to watch out for. If you experience any of the following, contact your doctor immediately.
Fever over 100.4 degrees
Chills
Dizziness
Heavy bleeding
Bleeding that lasts over two weeks
Prolonged or severe cramping
Unusual or foul-smelling discharge
Your Menstrual Cycle After a D and C
After a D and C, the uterine lining will build up in the uterus, just as it does after a normal menstrual cycle. Your cycle may arrive early, as expected, or late. Usually, women experience their first cycle within the first 2 to 6 weeks
Bleeding may be heavier than normal and you may experience clotting for the first cycle or two after a D and C. If you hope to conceive another baby, the standard recommendation is to wait 2 menstrual cycles after a D and C before trying to give the body a chance to restore.
Hope
If you have had a D and C due to a miscarriage, be encouraged that it is highly unlikely to impact your future fertility. In fact, after a couple months, many women go on to have healthy, full-term pregnancies.
While many of the causes of miscarriage are unknown, sometimes underlying factors can contribute to the likelihood of having a miscarriage. Factors such as hormone imbalance, thyroid concerns, infections, and inflammation can impact fertility. If you suspect this need to be the case for your body, reach out to a skilled functional medicine practitioner to help you restore optimal fertility.
Sources
https://www.acog.org/womens-health/faqs/dilation-and-curettage?utm_source=redirect&utm_medium=web&utm_campaign=int
https://my.clevelandclinic.org/health/treatments/4110-dilation-and-curettage-d--c