Perinatal OCD: Protecting Their Baby, One Obsessive Thought at a Time

Conquering Perinatal and Postpartum OCD My Battle to Stay Whole

Perinatal and postpartum OCD my downward spiral.

Ruth Zalta, right, with her children
Image Source: WebMD

Cradling her newborn son, Erin F. had a mental movie playing in her head. In this surreal scene, she tripped over a single step, sending scissors flying from the handrail. Unfortunately, the scissors impaled her arm and fatally stabbed the baby in her arms. Terrifying, right? (Erin asked iBioMed not to use her last name because of the stigma that comes with mental illness.)

After that incident, the 41-year-old first-time mom developed an intense fear of stairs. Any stairs. She just couldn’t shake the idea that harm might befall her precious child, so she felt compelled to be hyper-vigilant. Erin went to great lengths to ensure her baby’s safety. She sewed tiny tracking devices into his shoes as a precaution against potential kidnappings and placed choking rescue devices strategically throughout her home. Sleepless nights were spent sobbing on the couch, worried that another driver might rear-end them on the way to daycare. And the ocean? Forget about it – sharks were lurking in her mind’s eye.

Looking back, Erin now believes that she may have been living with undiagnosed obsessive-compulsive disorder (OCD) for most of her life. However, after giving birth and experiencing a traumatic postpartum preeclampsia episode, her thoughts became much more distressing.

“You feel like you’re going crazy because all these things that normally don’t terrify you are now terrifying,” Erin shares. “And everyone kept downplaying what I was going through, telling me it was normal and that I was doing great. But, no, I was falling apart.”

About nine months after her son was born, a psychiatrist finally diagnosed her with perinatal obsessive-compulsive disorder, or perinatal OCD. (Perinatal OCD refers to the period from pregnancy through the first year after childbirth. OCD that arises after the baby’s birth may also be called “postpartum OCD.”)

Perinatal OCD: More Common Than You Think

Neha Hudepohl, MD
Image Source: WebMD

OCD is known for its intrusive, repetitive, and often distressing thoughts, coupled with compulsive behaviors that temporarily alleviate the accompanying anxiety.

Perinatal OCD often manifests as thoughts of harm, illness, or death concerning the baby, according to Neha Hudepohl, a reproductive psychiatrist in Greenville, SC. Mothers experiencing perinatal OCD may excessively check if their infant is breathing or engage in other extreme measures. “They may have a hard time being away from their baby or letting other people care for or hold their babies,” Hudepohl adds.

Several studies suggest that OCD can develop or worsen during the perinatal period in around 17% of pregnancies. However, further research is needed to confirm these figures. The risks seem to peak after childbirth, a phase that is biologically and psychosocially vulnerable, explains Lauren Osborne, MD, a reproductive psychiatrist at Weill Cornell Medicine New York Presbyterian Hospital.

Lauren Osborne, MD
Image Source: WebMD

Individuals with a personal or family history of OCD, anxiety, or depression are at a higher risk, though some develop the condition without any prior indicators. Unfortunately, many people don’t seek the necessary care because they believe they can’t take medication “for the sake of the baby.” Osborne clarifies that this misconception is not in line with medical recommendations. Mental health conditions are common during pregnancy and childbirth, and most cases can be safely treated. “The medications we use for depression, anxiety, and OCD during pregnancy carry very low risks. In contrast, the untreated illnesses themselves can have a detrimental impact on both the baby and the pregnancy,” says Osborne.

While heightened anxiety and a keen sense of danger are to be expected for new parents, it is crucial to seek treatment when obsessive thoughts and behaviors begin to interfere with daily life or caregiving.

It’s important to note that individuals with perinatal OCD typically go to great lengths to prevent any harm coming to their infants. Some may conflate perinatal OCD with postpartum psychosis, a condition that poses a greater threat to the baby.

“Women are afraid to admit, ‘I have this horrible image of myself throwing the baby down the stairs,’ because they fear someone will take their child away,” says Osborne. “As a result, there’s even more shame and secrecy surrounding these symptoms.”

It’s Not Just About the Baby

Sometimes, the obsessive thoughts experienced by individuals with perinatal OCD don’t revolve solely around their infants. Take Ruth Zalta, for example, a 30-year-old who found herself grappling with crippling panic attacks that left her convulsing and sleepless. Her obsessive thoughts didn’t solely center on motherhood; they delved into topics like death, the meaning of life, and self-harm.

Zalta’s doctor prescribed medication, including a selective serotonin reuptake inhibitor (SSRI), which is generally considered safe during pregnancy and breastfeeding. Additionally, she underwent a form of evidence-based cognitive-behavioral therapy that included exposure and response prevention techniques. To confront her fears, Zalta surrounded herself with unsettling words and ideas. Sticky notes adorned with terms like “suicide,” “existence,” and “life” were placed strategically around her house. “I set alarms to engage in the exposure,” Zalta explains, “and I gradually became more desensitized, realizing that merely thinking something doesn’t mean I’ll act on it.”

Learning to Thrive with OCD

Thanks to her treatment, Zalta felt a remarkable sense of control by the time her daughter was born. Her symptoms have remained at bay over the past five years, even during and after the birth of her second child. She now dedicates herself to counseling work focused on OCD and perinatal mental health.

“At the time, my greatest fear was that I’d do something to leave my kids behind, and that fear still arises occasionally,” Zalta discloses. “But I realized I was stronger than I thought. That realization was incredibly empowering and brought about significant changes in my life.”

While intrusive thoughts still intrude upon Erin’s mind, she has learned to coexist with most of them. Her anxiety is eased somewhat by the fact that she has equipped her son with the skills to ensure his own safety, even enrolling him in a self-rescue swim class.

“One thing my therapist, psychiatrist, and doctor all emphasized was this: You have a toddler who depends on you, so empower him with the tools to protect himself,” Erin shares. “Knowing that if I look away for even a minute and he falls into the water, he’ll be alright and know what to do, brings me peace of mind.”

If you or someone you know is struggling with perinatal OCD or any mental health condition, remember that seeking help is crucial. You are not alone, and support is available.

Have you or a loved one ever experienced Perinatal OCD? Share your stories, thoughts, and strategies in the comments below!