Why We Should Really Be Talking About Postpartum OCD

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woman gently holding a newborn baby
© McKinsey Jordan / Stocksy United

There’s much to enjoy about a new little human — from peach fuzz hair to tiny fingers and toes. But, of course, along with the lovely things, there are scary things too. Namely the daunting responsibility of keeping your new little nugget alive and well.

But what if all you can think about are the endless terrible things that could happen to your baby? What if the dread of something going wrong keeps outweighing all those adorable, sweet moments?

When you have postpartum obsessive-compulsive disorder (OCD), you just can’t shake terrifying thoughts about your baby being harmed and, even worse, you causing the harm.

Growing awareness around postpartum mental health

You may have heard about postpartum depression, with some celebrities and influencers discussing their own struggles. Any effort towards making postpartum depression less taboo is a wonderful step forward for postpartum mental health, but there are other perinatal mood and anxiety disorders that are less understood, including postpartum OCD.

Around 3% to 5% of new mothers experience postpartum OCD, with symptoms usually popping up immediately after giving birth or within four to six weeks after. In one study of people with OCD, half of the female participants said that the birth of their child triggered their OCD. Another study found that, for women who already have OCD, symptoms got worse for half of them during the postpartum period. So maybe postpartum OCD is more common than most people think?

What postpartum OCD looks like

Postpartum OCD usually affects the mother or birthing parent, and it often includes having disturbing and irrational thoughts about harm coming to your baby. These thoughts are more than just the usual anxieties that affect most new parents and can include fears of you (or sometimes someone else):

  • Dropping or drowning your baby
  • Causing your baby to choke
  • Contaminating your baby somehow
  • Accidentally molesting your baby (while changing their diaper or bathing them)
  • Otherwise hurting your baby

It is important to understand these thoughts are not anything you would ever want to do and they do not make you a bad person — but just the act of having them can make you feel fear and shame. The thoughts can also lead to rumination (i.e., dwelling on your thoughts) and compulsions like obsessively washing your hands and/or your baby, checking on them way too much and either being too attached to your baby and never leaving their side, or avoiding them out of fear of what you might accidentally do.

Why do people get postpartum OCD?

Pregnancy and the postpartum period appear to set off new symptoms or worsen pre-existing symptoms for mood disorders like OCD. One factor that might possibly contribute to this is hormones.

“Looking back, we can see that symptoms often start or worsen around the time of hormonal changes,” says Dr. Juan Aparicio, a psychiatrist and fellow in the UW School of Medicine Department of Psychiatry and Behavioral Sciences who specializes in women’s mental health. “So, whether that's puberty, whether that’s pregnancy or postpartum, or whether that's menopause, we know that there's some hormonal impact that's often at play for OCD in general.”

There is no clear-cut reason why some people develop postpartum OCD. Experts do think that a family history of OCD and anxiety may up your chances of getting it and that the giant changes (physical, lifestyle, psychological) that you’re suddenly dealing with may also play a role.

How is postpartum OCD different from other conditions?

It’s easy to confuse postpartum OCD with other conditions. These include: 

Postpartum anxiety

Anxiety is quite common for new parents — much more common than postpartum OCD. After conception, many parents-to-be start stressing about the health and well-being of their baby. Anxiety tends to spike after delivery (and within the six weeks after) but also can show up anytime within that year. Physical symptoms can include chest pain, head and stomach aches and even panic attacks, with shortness of breath, shaking and sweating.

Postpartum depression

After giving birth, many people experience the “baby blues” for a few days — feelings of anxiety and overwhelm, mood swings and trouble sleeping. If these feelings don’t resolve within two weeks, it may be time to consider evaluation for postpartum depression. Postpartum depression is different because the symptoms can be severe and longer lasting and include excessive crying, trouble bonding with your baby, withdrawal from loved ones, intense irritability, severe anxiety and hopelessness. They also tend to interfere with your daily life, much like postpartum OCD, so it’s important to talk to your doc if you think you (or a loved one) have postpartum depression.

Postpartum psychosis

Postpartum psychosis is a medical emergency. Whereas postpartum OCD involves an obsession with protecting your child, if you’re experiencing postpartum psychosis, you might be considering (and even planning) to harm your child. Despite widespread misconceptions, postpartum psychosis is not just severe postpartum depression: it’s a true psychotic disorder that can cause you to hear voices and disconnect from reality — and it’s crucial that you get to the ER and get help immediately, as you may be a danger to yourself and your baby.

However, Aparicio emphasizes that it is important to note that severe postpartum depression can develop into postpartum psychosis (or postpartum depression with psychotic features), so again, it’s essential to reach out for help if you have any concerns.

How will my doctor know if I have postpartum OCD?

When it comes to screening for postpartum OCD, there isn’t a specific test that doctors give to new mothers.

“Postpartum OCD is often caught under anxiety screeners, which we do after giving birth,” says Aparicio. “Oftentimes in the anxiety screeners we’ll see something that looks more like OCD and say, ‘Hey, you should talk to this person, there might be something going on.’”

He also explains that during the baby’s check-ups, the doctor will often use the GAD-7 Anxiety Scale to check on the mother’s postpartum anxiety.

“Asking if they’re having scary, unwanted thoughts is one of the broadest, easiest ways to potentially open the conversation,” says Aparicio. “And then asking more specific questions like, ‘Are there rituals or routines that you've started that are taking over your day, or taking over your time, or getting in the way of you being the parent that you want to be?’”

He explains that it’s important for both the patient and the doctors to be able to differentiate the everyday, normal anxieties of new parents from something like postpartum OCD. For example: Are you peeking at the baby monitor or walking (quietly) by the baby to make sure that things are all OK? That’s totally normal. Or are you setting alarms for yourself to wake up to check on the baby every hour, or constantly waking the baby up to make sure they are breathing? At that point, you might be getting more into postpartum OCD territory.

Another way to differentiate is by monitoring how much time you’re spending on your baby-centric obsessions and compulsions and how much they’re interfering with your life. If checking on the baby, washing the baby, making sure everything is perfect in your house, etc. is preventing you from including your family in the baby’s care, or preventing you from getting sleep, or preventing you from being the kind of parent or partner you want to be — it’s important to talk to your doctor.

“We give a cut-off of greater than one hour,” says Aparicio. “If you are spending greater than an hour a day on these compulsions or on these obsessions, that is really taking up a substantial portion of your day, and you need to reach out.”

Part of the reason why postpartum OCD is not talked about as much is because of shame and fear. Having scary thoughts about your child being harmed (or you accidentally harming them) is not something that you want to talk about — especially during a time when you’re supposed to be all-loving and nurturing. You also might be fearful that if you mention how you're feeling, you risk having your baby taken away. 

What kinds of treatments are available for postpartum OCD?

Though treatments specific to postpartum OCD haven’t been studied extensively, there are some general OCD treatments that can be helpful.

"It seems that what works for OCD outside of postpartum is still effective,” explains Aparicio. “The same medication that we use for depression and for anxiety, often at higher doses, is effective for OCD. We also have medications that are compatible with breastfeeding that are in that category.”

He also emphasized the importance of cognitive behavior therapy (CBT), saying that the combination of medications and therapy together is usually the most effective method for helping patients feel better.

Another thing that’s important for treating postpartum OCD? Community support.

Dr. Esther Moy, an OB-GYN at the Childbirth Center at UW Medical Center – Northwest, explains that, since the weeks that follow giving birth are marked by so many physical and psychological changes and pure exhaustion from lack of sleep and newborn care, it makes sense that new or pre-existing mental health issues can arise.

“Your community of family and friends are instrumental to your postpartum recovery. You should be able to rely on family and friends for help with food, transportation, care of older children, and an extra set of hands for baby care when you need to rest,” she says. “Family and friends are also great external resources to monitor your mental health.”

How to get help

If you are experiencing postpartum OCD, you are not a bad person and you’ve done nothing wrong, so don't be afraid to speak with your doctor.

“I want everyone to know that it’s common to have these worries, and they are not indicative of your ability to be the kind of parent you want to be,” says Aparicio. “Oftentimes people take the thoughts that come with postpartum OCD as some sort of moral judgment of who they really are, and that's just not true. The data shows us that people with OCD are not unsafe. They're just having intrusive thoughts, and it doesn't make them a bad person or an unsafe parent."

Parenting is a tough job — don’t make it even harder on yourself by not reaching out for the help that you deserve. If you think you might be experiencing postpartum OCD, speak to your healthcare team.