Update, March 25, 2021: A new study out of the University of British Columbia suggests postpartum OCD might be more common than previously thought. The study estimates that 17 percent of postpartum women report symptoms that meet criteria for a diagnosis of OCD in the 38 weeks after delivery. Prior research had estimated the prevalence of OCD at about 2.2 percent over the pregnancy and postpartum period.
Alexis Stephenson’s* baby was just a few weeks old when the first-time mom started having images of her family getting into a horrific car accident. Chalking it up to a traumatic few weeks—she had a difficult delivery and found out her baby had a heart defect—she tried to ignore them.
But instead of going away, the images intensified. She would imagine her daughter Julia’s neck snapping. Being around knives made her chest tighten and her breathing get shallow—she just couldn’t shake the feeling that knives were a danger and shouldn’t be near the baby. “When I was making coffee, I was sure I was going to scald her. I saw her spinning around in the dryer. I started to become more and more scared of household appliances,” recalls the 37-year-old university professor who lives in Calgary.
Stephenson was experiencing intrusive thoughts—fears, thoughts or images she knew were not real, or not in line with what she would want to do. She mentioned them to her family doctor and was referred to a mental health clinic where she was informed those thoughts were a sign of obsessive compulsive disorder (OCD). Some women with OCD experience images of unintentionally dropping their baby down the stairs, or accidentally drowning them in the bath. While it’s not uncommon to have intrusive thoughts (have you ever been in a museum and had an urge to touch a painting? Or imagined yourself jumping out of a moving car?), when you can’t get those thoughts out of your head, they become obsessions—and these obsessions are the hallmark of OCD. Often, these obsessions come with associated compulsions; for example, if you’re fixated on germs, you may wash your hands relentlessly. A woman experiencing OCD after having a baby might be afraid of illness and therefore wash her baby multiple times a day or sterilize bottles incessantly. Though Stephenson didn’t have compulsions, she was diagnosed with OCD which is a specific type of anxiety disorder. While a woman with postpartum depression feels very sad and might withdraw from her baby or social circle because she feels overwhelmed or worthless, a woman with OCD is afraid she’ll inadvertently do something to hurt her baby.
“The postpartum period is especially vulnerable for relapse or onset of OCD,” says Deirdre Ryan, psychiatrist and medical director of B.C. Children’s Hospital’s Reproductive Mental Health Program. A Canadian study from 2016 found that 3.6 percent of pregnant women experience postpartum OCD, while it’s estimated that 1.6 percent of women experience OCD that’s not tied to pregnancy. Ryan explains the rapid shift in hormones from pregnancy to delivery, coupled with sleep deprivation, a history (or family history) of anxiety and the pressure of taking care of a newborn can increase the risk of any postpartum mental illness, including OCD.
It’s fairly common to have a thought or two that causes anxiety after having a baby, says Simone Vigod, a psychiatrist who leads the Reproductive Life Stages Mental Health Program at Women’s College Hospital in Toronto. But if you aren’t able to shake them off, they’re likely intrusive thoughts. And if those thoughts are still distressing you after four or six weeks, without improvement, Vigod says treatment might be required.
It becomes a problem when the thoughts or images are time-consuming and start to interfere with your ability to take care of yourself or your baby. Stephenson, for example, started getting nervous in parking lots, getting a visceral feeling that Julia would get run over if she put her infant car seat down for a moment to reach for her keys or put the groceries in the trunk. She was afraid to be alone with Julia. “At the most severe point, I would just be sitting on the couch picturing Julia tumbling around the dryer. This could go on for six to eight hours a day.” Stephenson asked her mom to fly in for support until she started to feel better.
One of the difficulties with having these intrusive thoughts postpartum is that women often suffer in silence because they are afraid of talking about what they are experiencing. “Women are worried that people will think they actually want to do something to their baby. When in fact it’s the exact opposite—they’re terrified that something bad would happen,” says Vigod. Women also confuse what they are going through with psychosis—if they can imagine drowning their baby in the bath, does this mean one day they will snap and do it? But postpartum OCD is vastly different (and more common) than postpartum psychosis. “With a psychotic illness, the woman has lost touch with reality. She is not distressed by the thoughts she is having, because she thinks she’s doing the right thing,” says Ryan.
The good news: postpartum OCD is treatable. If you’re having strange or unwanted images or thoughts about your baby, Vigod suggests bringing it up with your doctor. She may be able to normalize what you’re going through, which could be enough to get you through the first few weeks after delivery until the thoughts subside. But if they are affecting your day-to-day life, ask for a referral to a mental health clinic.
Postpartum OCD is usually treated with a combination of cognitive behavioural therapy and antidepressant medication. Keep in mind it won’t be a quick fix: therapy takes at least eight to 12 sessions, and most women will need to be on medication for at least six months, although they’ll start seeing some relief from the thoughts after about two weeks, says Ryan. Some women are hesitant to take drugs when breastfeeding—particularly because they’re so worried about something bad happening to their babies—but doctors agree that the benefits to keeping moms healthy are worth the risk of the very low levels of medicine that are passed on to their babies. The cognitive behavioural therapy is also helpful to give women tools to deal with the fears and obsessions if they begin to experience a relapse later in life or during another postpartum period.
Stephenson, who was breastfeeding, was put on Zoloft, and over the course of three months, the thoughts came less and less frequently. Now, she’s off the medication and Julia is a happy 18-month-old. Recently, Stephenson and her husband were walking near a river when she had a fleeting image of Julia tumbling into the water. “I thought, ‘well, I should just watch her closely,’” says Stephenson. And, with relief, the image left her mind and she kept on walking.
*Name has been changed.