OCD around childbirth

Introduction

During pregnancy and around childbirth, you may experience very distressing thoughts that frighten you. Most people have thoughts like these, but for some they become a serious problem. People often keep these thoughts to themselves as they try to understand why they arise and prevent them from coming back. The way they try to manage the thoughts can become a large part of the problem and lead to OCD with obsessions and compulsions.

OCD that develops after childbirth is known as postpartum OCD, abbreviated to ppOCD. Parents with postpartum OCD may be troubled by unwanted thoughts about their baby and doubts about their feelings and the care they provide. Becoming a parent brings responsibility for caring for your child. This can feel overwhelming and frightening, especially if you also struggle to make sense of your own thoughts and reactions.

What is postpartum OCD?

For some mothers and fathers, becoming a parent can trigger postpartum OCD, a common anxiety disorder characterised by unwanted and disturbing thoughts, images or impulses. Symptoms may begin suddenly after childbirth, or existing OCD symptoms may intensify with the new responsibilities of parenthood.

In postpartum OCD, you may doubt your feelings for your baby and whether you are providing enough care and protection. Thoughts can also be sexual or concern harming the baby accidentally or deliberately.

In a US study, around 11% of women screened positive for OCD symptoms at the assessments 2 weeks and 6 months after childbirth.*Fodnote

The fear of not loving your baby

In postpartum OCD, doubt can also centre on whether you love your baby enough. You may become preoccupied with checking whether the right feeling is there and comparing your reactions with those of other parents. Some parents also look at photographs of their baby again and again, trying to evoke the feeling of love they believe they should have. You might mentally review the time you have spent with your baby or repeatedly seek reassurance from your partner to become certain of your feelings. This can take up a great deal of time and make it difficult to be present with your baby.

The fear of not giving your baby enough stimulation

Fear of not giving your baby enough stimulation can make you feel you must always be available and actively engaged with them. You may feel compelled to keep playing, talking and maintaining eye contact to make sure your baby has enough interaction and stimulation. Time with your baby may also become dominated by repeated checks on whether you are doing enough, comparisons with other parents and repeatedly reading advice about your baby’s development.

Looking away, taking a break or turning your attention to other tasks can trigger doubts about whether you have neglected your baby. This can make it difficult to prioritise eating, showering, resting or getting practical tasks done. Guilt can lead to attempts to compensate with even more interaction and make it difficult to be spontaneous with your baby.

The fear of not giving your baby the nourishment and care they need

Doubt can also centre on whether your baby is receiving enough nourishment, comfort and care. You may mentally review breastfeeding, bottle-feeding or mealtimes again and again to be certain that your baby has had enough. You may repeatedly analyse your baby’s crying and other cues, and seek reassurance from your partner that you have responded correctly. A decision you have already made can continue to give rise to doubt. You may feel compelled to change routines again and again in an attempt to be completely certain that your baby is receiving the right care. The search for certainty can continue even after your questions have been answered.

The fear of infection and contamination

Some parents find it difficult to let go of doubts about whether hands, feeding bottles, toys and their baby’s surroundings are clean enough. You may wash or sterilise the same things again and again and still be unsure whether you have missed something. It can become difficult to stop cleaning, even when you have already repeated it several times.

The fear may also concern other people bringing infection or contamination with them. Some parents limit visits or avoid letting others hold their baby in an attempt to protect them. You may end up caring for your baby with less support.

Unwanted thoughts of harming your baby

Unwanted thoughts of harming your baby can take the form of sudden mental images of doing so, for example when your baby is crying and difficult to comfort. A parent whose baby has colic may be frightened by such a thought and begin to fear losing control.

You may go over the thought again and again, monitor your reactions or seek reassurance from your partner. Some parents begin to avoid certain situations with their baby or let others take over caring for the baby for fear that the thoughts will return. This can make time together tense and bring feelings of guilt about not being able to spend time with your baby in the way you would like.

Unwanted sexual thoughts

Unwanted sexual thoughts about your baby can arise during a nappy change or bath. They may be experienced as thoughts, mental images or the sensation of an impulse. For example, you may become afraid of touching your baby inappropriately and feel unsure about what the thoughts say about you.

You may go over the situation in your mind or check whether your body reacted in a particular way. Shame and fear of other people’s reactions can make it difficult to talk about the experience. Some parents begin to leave nappy changes or bathing to others. These attempts to become certain and this avoidance behaviour can help maintain OCD.

Unwanted thoughts about your baby being in danger

The fear that something has happened to your baby can arise while they are asleep in their cot or pram. A parent may become preoccupied with whether their baby is breathing and feel compelled to check immediately. The thought of having overlooked something can make it difficult to wait or turn your attention to other tasks.

After checking, doubt can quickly return: Was I thorough enough, and can I trust what I saw? You may therefore go back again and again or ask your partner to check as well. It can become difficult to rest while your baby sleeps.

How can I tell if my partner or someone close to me has postpartum OCD?

If you are close to the parent, you might notice, for example, that they:

• avoid holding the baby or sitting with them in their arms
• constantly try to play, talk or maintain eye contact with the baby and find it difficult to take breaks
• excessively wash or sterilise feeding bottles and other things the baby puts in their mouth
• wash the baby’s and the family’s clothes or clean the baby’s surroundings excessively
• isolate the baby to prevent family members or other people from “contaminating” them or giving them an “infection”
• check the baby’s breathing and safety again and again
• repeatedly seek reassurance about their feelings for the baby, whether they are a good mother or father, and whether the baby is receiving enough care
• seek reassurance that a particular action has not harmed the baby

These visible signs may be the “tip of an iceberg” of obsessions and compulsions, but they can also fall entirely within normal behaviour. People differ widely in their cleaning and hygiene routines and in how closely they watch over a newborn. The examples above therefore do not necessarily indicate OCD, but they are worth paying attention to.

Postpartum depression and postpartum OCD

Obsessions can also occur in postpartum depression. In one study, 21 of 37 women with postpartum depression reported obsessions. This corresponds to 57% of the women in the study.*Fodnote

Many people feel ashamed of the thoughts and keep them to themselves. They try to get rid of them through thought control, but the attempt has the opposite effect and intensifies the unwanted thoughts. The thoughts often become both more frequent and more intense, and arise in more and more situations.

The thoughts and the attempts to manage them place a heavy strain on parents at a time that is already demanding because of the new family member. This strain can lead to reactions resembling depression, while OCD is the underlying problem.

Why does postpartum OCD develop?

Research does not provide a clear answer as to why postpartum OCD develops. OCD has often been present but unrecognised before postpartum OCD develops. The vast majority of parents experience unwanted thoughts about harming their baby. If you already have a tendency to develop OCD, it will often emerge during this period.

OCD during pregnancy

A substantial number of women and men also experience distressing, unwanted thoughts during pregnancy, including thoughts about harming the unborn baby. Fears may concern food intake or bacteria, and the thoughts may also involve magical thinking. You may fear that something you see or think will affect your baby’s health.

Trying to make everything ideal for your unborn baby can become an intense and distressing preoccupation. A sense of fragility and catastrophic thoughts can maintain this focus: “If I do not do everything right during pregnancy, my baby could be affected, and then it will be my fault.” Worries may concern, for example, the mother’s condition, sleep, food intake, vitamin supplements or everyday exposure to pesticides.

Postpartum OCD and men

Fathers can also experience OCD during pregnancy and around childbirth.*Fodnote Their thoughts may involve many of the same themes described in this article. There may also be OCD themes that do not focus directly on the baby. For example: “To keep my family safe, I must not start anything at certain times of day” or “By thinking about or seeing certain words, I bring misfortune upon us.” These themes can also occur in women.