There are two main procedures used for carrying out a TFMR: a surgical approach (D&C) or a medical approach (induction of labour), depending on the gestation of the pregnancy.
Surgical – Dilation and Curettage
The surgical approach is most common and is called a dilation and curettage (D&C) sometimes called a dilation and evacuation. This is a procedure where your cervix is opened with a small instrument and the uterine tissue and fetus is removed.
On the day of admission to the day surgery, the woman will be given medications to soften the cervix allowing for easier access. This medication can cause cramping and bleeding however, the baby will only feel a slight swaying or movement.
When the woman is taken into the theatre, she will usually be placed under a general anaesthetic or heavy sedation. As the woman fall asleep so does the baby, however the baby will not wake up. There is no pain for the baby. It is gentle and peaceful.
Whilst under anaesthetic, the doctor will empty the contents of the uterus. Depending on the circumstances this may be done under ultrasound guidance. Ultrasound is preferable as the procedure is a ‘Blind’ one, that is, done by feel rather than sight. Ultrasound can help confirm that the procedure is complete.
Once awake the woman will be monitored until ready to go home. Afterwards she may experience mild cramping and will likely spot for a few days and up to two weeks. The woman’s period is likely to return approximately four weeks after the procedure, however there may be delays and if more than two months have gone by it is worth seeking further advice.
A sample of the fetus or of the placenta may be sent away for testing, however, the fetus is treated gently and with care before being cremated by the hospital. If the woman/parents want to take the baby or the ashes home, it is something that can be discussed with the medical professional.
Medical – Induction labour
Induction labour or induction abortion is similar to a labour and is an option for later stage TFMRs; however, as the birth will be taking place earlier than full term, the baby will be smaller meaning the labour might be shorter.
The woman/parents may be asked to come in the day before the induction to have blood work, ultrasounds and medications. The medications that may be used are cervical softeners in order to expand the cervix ready for labour. Depending on how far through a pregnancy the woman is, an injection may be given into the woman’s abdomen to send the baby to a sleep that they won’t wake up from. This injection does not cause the baby any pain and makes the labour less traumatic for all involved.
When it is time to go into labour the woman will be given Oxytocin in an IV line which will bring on contractions. The contractions will begin which will feel like cramps that will become intense just like in a normal labour. Also, like normal labours the woman will be offered pain relief.
After the birth the woman/parents will be offered to spend time with the baby if they wish. The woman/parents may choose whether the baby is cremated or buried. There are many elements of the birth and what happens after the birth that the woman/parents will have control over.
In the Weeks After
A TFMR involves removing the placenta from the woman’s uterine lining. When this happens the woman’s hormonal system is shocked. It takes time for the body to readjust back to normal.
When a woman is pregnant, she gets a surge of Oxytocin which is designed to develop and form a chemical bond between mother and baby. When the Oxytocin is gone the woman physically and emotionally feels that loss.
During the first stages of pregnancy the body begins preparing the breasts to produce milk. When a woman has a TFMR the body thinks it has given birth which means the colostrum and milk begin to be produced in small amounts after the baby is gone. This can be overwhelming and upsetting for many women.
It takes approximately 4-8 weeks for a woman’s period to return and during that time there will still be the pregnancy hormone human chorionic gonadotropin (HCG) present in the woman making pregnancy tests still positive. Despite this some women ovulate as soon as two weeks following the termination.
Other side effects can be dizziness, hot flushes, twinges and cramping.
There is one fact that a lot of women take comfort from, during pregnancy the mother and the baby exchange small amounts of cells. This is called microchimerism. This means that the mother has a biological connection with every child she has carried in her womb at a cellular level until she dies. No matter whether they are born, miscarried, stillborn, aborted or TFMR.
Emotionally, woman can all feel very different. There can be a variety of emotions both positive and negative. Some feel anger, resentment, blame, self-blame, regret, empowerment, certainty, relief and loss. It is important no matter how you feel to know what you are experiencing is not wrong. It is also important to give yourself time and seek help if you need it. Most women feel confused about their feelings, feeling guilt about the decision whilst also knowing it was the right decision for their circumstances.
If you are in need of emotional support, our resource may help you. The Turmoil of Termination – Pink Elephants Resource
 Mayo Clinic, 2020, Dilation and Curettage (D&C), https://www.mayoclinic.org/tests-procedures/dilation-and-curettage/about/pac-20384910