“What if I hurt my baby?”, “Why aren’t they moving right now?”, “Am I unknowingly harming them?”.
Naturally, a big part of being a mother is worrying–constantly being concerned for your baby’s well-being, making sure you aren’t doing anything that can harm them, and the list goes on. But when fears turn to obsessions–when concerns start to spiral–it may be OCD creeping up on you.
Most people hold a warped notion of OCD–that it’s all about neatness and cleanliness. But this isn’t always the case. In pregnancies, especially, OCD can rise in more complicated forms, making the already stressful task of motherhood much harder to manage.
What is postpartum OCD?
OCD tends to follow a pattern of its own. It starts with an obsession (What if my baby died? What if I harm my baby? What if I’m a danger to them?), one that takes control of your daily life–one that comes intrusively. Then, it turns into a compulsion (Trying to get your baby to move, avoiding touching your stomach, avoiding knives or other weapons, etc.), which is your brain’s way of taking control–of keeping the baby as safe as possible.
But, like with every OCD sufferer, you aren’t actually a threat. It may be hard to stomach this. It may be hard to completely accept that you aren’t a bad mother–that you aren’t a danger to your baby. OCD has unique ways of always creating doubt. Whether you constantly worry that you’ve miscarried, or whether you worry about directly harming your baby, there’s no limit to the fears OCD can plant–even if seemingly irrational. But OCD does exactly that: make the impossible feel possible, probable even.
What do intrusive thoughts about harming your baby mean?
Intrusive thoughts in general are very common postpartum, with research estimating upwards of 90% of mothers (or more) will have an intrusive thought. In OCD occurring postpartum, intrusive thoughts tend to focus on the baby’s safety (e.g., is she still breathing? what if I drop my baby?) and the accompanying compulsions meant to ‘get rid’ of the thoughts involve behaviours such as mental counting or rehearsing (e.g., I need to count to 10 every time I climb the stairs carrying my baby) or overt behaviours, such as excessive handwashing if the fear is contamination of baby.
We know from research that having a thought that you might harm you baby is not correlated with risk of actually harming your baby. For mothers suffering from OCD postpartum, they experience a great deal of distress and subsequent shame when it comes to having these thoughts. Having intrusive thoughts simply means you are a human being wired, as we all are, to protect your baby and be on the lookout for threat.
Does having these thoughts mean I want to hurt my baby?
No. I will reiterate, having a thought about harming your baby is not correlated with actually harming your baby. A thought and intent to harm are two very different things. For women struggling with OCD postpartum, thoughts tend to be ego-dystonic, meaning the thoughts go against their moral compass and are as distressing as they are because the content of the intrusive thoughts goes against your very nature.
How is postpartum OCD different from postpartum psychosis?
The content of the thoughts suffers of postpartum OCD and postpartum psychosis experience tend to not be much different. However, associated symptoms differ markedly: in postpartum psychosis, women will experience delusional thinking patterns, hallucinations, and what we call negative symptoms e.g., lack of self-care. In contrast, in postpartum OCD women will experience excessive anxiety, avoidance, compulsive rituals, attempts to suppress their thoughts and often experience depression as well.
In postpartum OCD, the thoughts are experienced as unacceptable and inconsistent with one’s worldview; in postpartum psychosis, thoughts are accepted as true. In postpartum OCD, obsessions are resisted through avoidance, rituals, and thought suppression (i.e., attempts made to ‘push’ the thoughts away), whereas in postpartum psychosis the delusions are not resisted.
There is very little if any risk of harm in postpartum OCD. Postpartum psychosis is a medical emergency and requires hospitalization and prompt medical attention.
What are compulsions in postpartum OCD?
Compulsions in OCD are repetitive behaviours or mental acts: any attempts to neutralize, prevent, or reduce distress related to obsessions. The compulsive behaviours may be related to or unrelated to obsessions, and are very time-consuming and impede on one’s functioning in daily life.
If you’re struggling with these thoughts, try this:
Take a moment to sit and listen to these scary thoughts OCD can conjure up. With it comes a strong fear response. Try and focus on that fear. Try not to entertain or talk back to these thoughts–but rather–focus on where you feel that sensation of fear. Maybe it's in your chest? In your stomach? Then, like we mention in our previous article, try a conscious deep breathing exercise. Often, the cycle of OCD is broken by not engaging in compulsions–in resisting entertaining these thoughts. Because that’s all they really are in the end: thoughts.
When should I seek help?
Postpartum OCD is treatable! Dr. Sarah Haller (Clinical Psychologist) used exposure and response prevention (ERP), the gold standard to treating OCD. If you are finding your thoughts are continuing to feel distressing, if you are unsure whether it is general anxiety or OCD you are experiencing and would like an expert assessment, or if you simply are seeking space to talk through your concerns and some strategies for managing the obsessive thought cycles, reach out to us.
How is postpartum OCD treated?
We treat postpartum OCD using exposure and response prevention (ERP), a form of CBT that is the gold standard of OCD treatment. Dr. Haller will work with you to build a treatment plan that gradually targets your obsessive thoughts and compulsions and provides freedom from the behaviours that have been keeping you stuck. To learn more about treatment, visit our Pregnancy and Postpartum page.
If you feel that you’re struggling with these thoughts, know that you are not alone. You are not evil. You are a mother dealing with one of the many struggles that can come with motherhood. Millions are in your shoes, and millions come out the other side feeling supported.
OCD is an incredibly common struggle during pregnancy–but many mothers go unwarned. Fears may come of hurting your baby, and with it, a stigma and worry that you’ll be judged–shunned for it. But, this is not the case. OCD is a common issue for mothers, and a trained therapist will recognize the signs and offer a multitude of options to support you, and make sure you feel more reassured.
Author: Ryan Elahi
Reviewed and Edited by Dr. Sarah Haller, C. Psych, Clinical Psychologist