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 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, you will be given medications to soften your cervix allowing for easier access. This medication can cause cramping and bleeding however, the baby will only feel a slight swaying or movement.
When you are taken into the theatre, you will be placed under a general anaesthetic or heavy sedation. As you fall asleep, so will your baby, however he/she will not wake up. There is no pain for your baby. It is gentle and peaceful.
Whilst under anaesthetic, the doctor will remove 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.
You will wake up in recovery and will be monitored until you’re ready to go home. Afterwards you may experience mild cramping and will likely spot for a few days and up to two weeks. Your period will likely 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 you would like to take the baby or the ashes home, it is something that can be discussed with the medical professional.
Medical – Induction of Labour
Induction of labour is similar to a labour and is an option for TFMRs. You may be asked to come in the day before the induction to have bloodwork and ultrasounds done, and to receive medications such as cervical softeners that will expand your cervix ready for labour.
Depending on how far through a pregnancy you are, an injection may be given into your 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 you 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 you will be offered pain relief.
After the birth you will be able to spend time with your baby if you wish. You may choose whether the baby will be cremated or buried. There are many elements of the birth and what happens after the birth that you will have control over and be involved in.
In the Weeks After
Because a TFMR involves removing the placenta from your uterine lining, your hormonal system will be 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 being 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 your system, 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 which is that 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, women can all feel very different and there will 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 to know that no matter how you feel, 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 and are currently faced with this heartbreaking decision, our The Turmoil of Termination resource may help you.
 Mayo Clinic, 2020, Dilation and Curettage (D&C), https://www.mayoclinic.org/tests-procedures/dilation-and-curettage/about/pac-20384910