What’s the difference between a D&E and L&D?
When facing the heartbreaking decision to terminate a pregnancy for medical reasons (TFMR), parents may have the ability to decide how to terminate. Two of the most common termination procedures include Dilation and Evacuation (D&E) and Labor and Delivery (L&D). Understanding the differences between these procedures and their potential pros and cons can help parents make informed decisions during such a challenging time.
Dilation and Evacuation (D&E)
D&E is typically performed between 13 and 24 weeks of gestation. It involves dilating the cervix and using surgical instruments to remove the fetal tissue. The procedure is usually completed in one day, though it may require two days if additional cervical dilation is needed.
Pros:
Procedure Length: D&E is generally quicker than L&D, often taking a few hours from start to finish.
Less Physically Demanding: The physical demands on the mother's body are typically less intense compared to L&D.
Cons:
Limited Gestational Range: D&E is not typically performed beyond 24 weeks of gestation.
Surgical Risks: As with any surgical procedure, there are risks, including infection, bleeding, and injury to the uterus or other organs.
Due to the nature of the procedure, parents may not be able to hold their baby. They may request footprints.
Labor and Delivery (L&D)
L&D involves inducing labor to deliver the fetus vaginally. This procedure can be performed at any gestational age but is more common in later stages of pregnancy. It usually involves the administration of medications to induce contractions and may take several hours to days to complete.
Pros:
Opportunity for Closeness: The process can allow parents to see, hold, and say goodbye to their baby, which can be an important part of the grieving process for some.
No Surgical Risks: L&D avoids the surgical risks associated with D&E.
Cons:
Lengthy and Physically Demanding: The process can be lengthy and physically taxing, often requiring pain management and significant recovery time.
Potential Complications: As with any labor, there is a risk of complications such as excessive bleeding or infection.
Parents usually deliver on an L&D floor and see living babies as they depart from the hospital.
How to Choose
The choice between D&E and L&D is deeply personal and can be influenced by various factors, including the gestational age of the pregnancy, medical recommendations, and the parents' preference. Consulting with a healthcare provider is crucial to understand the specific risks and benefits in each individual case.
It's important for parents to feel supported and informed during this time. Seeking the guidance from a TFMR-trained therapist can provide emotional support and help parents navigate their feelings and decisions.