Perinatal OCD: scary thoughts in pregnancy and after birth

Perinatal OCD can begin in pregnancy or after birth. After birth, it can start suddenly, within days or weeks, or come on more gradually.

It may be more likely with a first baby, but it can happen after any pregnancy.

Experts think hormone changes and the huge new sense of responsibility for a baby both play a part. Research is still growing.

Having had OCD before raises the chance. OCD can also run in families.

Some worry and scary thoughts are normal for new parents and pass with time. It becomes a concern when they are intense, keep going, or get in the way of daily life or caring for the baby.

With OCD, the thoughts and rituals often take up at least an hour a day, and often much more.

With a new baby, your brain is wired to spot any possible danger. Sometimes it throws up the worst thing it can imagine.

Most people notice the thought and move on. With OCD, the thought feels like a warning that must be acted on, so it sticks.

Researchers found no evidence that these thoughts, or OCD, were linked to a higher risk of harming a baby.

The Maternal OCD charity says there is no reported case of a mother acting on her obsessional intrusive thoughts.

Worries about accidents, sudden infant death or the baby being taken are common. So are worries about something you ate or did in pregnancy.

Sudden thoughts or pictures of harming the baby on purpose are among the most distressing. They feel completely “not me”, which is exactly why they cause so much fear.

Some parents fear germs will make the baby seriously ill or die. This can lead to constant washing and sterilising.

Unwanted sexual thoughts about the baby are a known OCD theme. Parents may also fear that others will suspect them. These thoughts are not desires.

Perfectionism can show up as worry about not sterilising a bottle properly, leaving doors unlocked, or needing things to feel exactly right.

Some parents have religious worries, about the baby’s soul, morality or religious upbringing. Others fear losing control or “going crazy”.

Checking can include watching the baby breathe, tracking feeds and nappies closely, calling health providers or searching online for answers.

Repeated or excessive washing, cleaning and sterilising are common rituals in perinatal OCD.

Some parents avoid bathing or changing the baby, hide knives, skip baby groups or avoid being alone with the baby.

Avoidance can feel protective, but it often makes the fear grow and can add to guilt.

Asking others over and over for reassurance is a common compulsion.

Mental rituals include counting, praying, repeating a word or reassuring yourself in your head. They are invisible, so others may not know how hard you’re working.

In OCD, you know the thoughts are unwanted and you are distressed by them. You try hard to avoid or undo them.

Postpartum psychosis affects 1 to 2 in 1,000 women and can come on within hours or days of birth. It can involve rapid mood swings, beliefs that aren’t true (delusions) and seeing or hearing things that others don’t (hallucinations).

Perinatal OCD is different from postnatal depression, but some women have both and need care for each. Postpartum anxiety and PTSD can also be mistaken for OCD.

Many parents fear that if they say the thoughts out loud, people will think they are dangerous. Perinatal mental health experts know that OCD thoughts are not acted on.

You can ask your provider directly how they handle these conversations. Choosing a provider who knows about perinatal OCD can help you feel safer.

• Bring someone you trust to the appointment
• Show this guide and point to what fits
• Start with: “I’m having scary, unwanted thoughts about my baby, and they won’t go away”
• Write it down and hand over the note

The “What I want my provider to know” worksheet can help you prepare.

The International OCD Foundation (IOCDF) has a directory of OCD therapists and clinics. Postpartum Support International can connect you with perinatal mental health providers.

In ERP, you work with a therapist to face feared thoughts or situations a little at a time, while resisting the compulsion. Over time the anxiety settles by itself and the thoughts lose their power.

For example, a parent might work up from standing near the bath, to holding the baby during bath time, to bathing the baby alone.

CBT is usually weekly. It takes effort and practice at home, and it has no reported side effects.

The aim is for you to become your own therapist by the end of treatment.

Some people use other treatments as well as therapy. Decisions in pregnancy and while feeding a baby should be made with a professional.

Naming a thought as OCD can create a little distance. You don’t have to argue with it or prove it wrong.

Try: “I’m having the thought that… It’s OCD. I can let it be here and carry on.”

Resting and accepting help with the baby are part of recommended self-help.

Delaying a compulsion, even for a few minutes, can show you the anxiety rises and then falls on its own. A therapist can help you build on this safely.

The Royal College of Psychiatrists advises against using alcohol or drugs to manage anxiety.

Postpartum Support International runs free online support groups. The IOCDF also lists support groups and parent stories.

Reassurance-seeking is a compulsion. Answering “Is the baby okay?” again and again brings short relief but can feed the cycle.

Instead of cutting off reassurance suddenly, agree on a plan with your partner and their therapist. You might say: “I know this feels scary. I believe you can handle not knowing.”

Perinatal OCD can happen to any parent, including fathers, same-sex partners and adoptive parents, whether or not they gave birth.