Obsessive compulsive disorder (OCD) in pregnancy

What is OCD?

If you have OCD you’ll have obsessive thoughts and compulsive behaviours.

Obsessive thoughts are unwanted, unpleasant and often distressing thoughts or images that keep coming back into your mind. These thoughts can make you feel anxious.

Compulsive behaviour is when you repeat an action (such as washing, checking or counting) to lessen the anxiety caused by obsessive thoughts.  

For example, if you have an obsessive fear about your house being burgled you may check that your doors are locked several times before you go out.

Doing something again and again may make you feel better for a while but then the anxiety will come back.

Perinatal OCD

If you get OCD in pregnancy or after childbirth it is known as perinatal OCD. Perinatal OCD symptoms are often about the baby, but not always.

Having a baby changes your life and can be very stressful. It’s normal to have some worries and anxieties about your baby’s wellbeing. You will also want to protect your baby from risks, so you will do things to minimise them, such as sterilise feeding bottles or occasionally check on them as they sleep.

But you may have perinatal OCD if you spend a lot of time thinking about these worries and anxieties and develop obsessive thoughts and compulsive behaviours because of them.

For example:

• you may have obsessive thoughts about your baby being harmed by germs or infections and so spend a long time cleaning or sterilising things multiple times.
• you may have obsessional thoughts about your baby stopping breathing and so check your baby constantly.

“I kept thinking that something was going to happen to my baby son if I went to sleep. I panicked about any little movement he made, thinking it may be a seizure. I started taking his temperature every hour and I was too afraid to leave the house in case he caught a bug.”

Sarah

You may have a picture in your mind of hurting your baby in some way. This can be very frightening but we know that women with OCD do not act on these thoughts.

Perinatal OCD is more likely to happen to first-time mothers, but you can have it during or after any pregnancy.

How common is perinatal OCD?

OCD affects about 1 in every 100 women in pregnancy. This is like the rates in the general population. Perinatal OCD is more common after birth than in pregnancy. About 2 to 3 in every 100 women are affected by perinatal OCD in the year after giving birth.

What causes OCD?

It’s not clear exactly what causes OCD, but you are more likely to develop the condition if you:

• have a relative with OCD
• have had OCD before
• are under a lot of stress
• have experienced an important life event, such as childbirth or bereavement
• are a neat, organised person with high personal standards.

What should I do?

It’s important to tell your midwife or GP if you are having symptoms now or if you’ve had OCD before.

Some women may feel embarrassed about the thoughts they have and the repeated actions they are doing to control their anxieties or fear. If you are concerned try to remember that OCD is a common mental health condition. It can affect anyone at any age and is not your fault. The midwife or doctor won’t criticise you or judge for having these thoughts. They are there to help you find the best treatment so you can get better.

It can be difficult to talk about your thoughts and repeated actions. It may help to write down what you want to say first, or you may want to have someone with you.  The important thing is to let someone know so you can get treatment as soon as possible. 

Treatment options

Your doctor will discuss the options available with you. Some people with mild OCD may not need treatment.

The two main treatments are:

Talking (psychological) therapy

This will usually be cognitive behavioural therapy, which will help you face your fears and obsessive thoughts without doing anything about them (i.e compulsive behaviour). This can be offered at different intensities, depending on how severe your OCD is. 

Medication

Your healthcare professional may suggest medication. They will talk to you about the risks and benefits of taking these while you’re pregnant. 

How can I help myself?

• Talk to your partner, family or a friend about how you are feeling.
• Try not to feel guilty or embarrassed. These thoughts are not your fault and you are not ‘going mad’.
• Instead of trying to avoid or ‘fix’ your obsessive thoughts with a compulsive action, try to face them. Spend half an hour a day writing them down and reading them.
• Don’t use alcohol  or smoke  to calm yourself down. Both can harm you and your baby.
• Use a self-help book. You can find some recommendations below.

More reading

The books below are recommended by the Royal College of Psychiatrists. You may be able to get them on prescription from your GP through the Reading Well Agency: Books on Prescription scheme.

• Understanding Obsessions & Compulsions: A self-help manual by Frank Tallis, Sheldon Press.
• Overcoming Obsessive-Compulsive Disorder: a self-help book using cognitive-behavioural techniques by David Veale and Robert Willson, Constable and Robinson.
• Break Free from OCD: Overcoming Obsessive Compulsive Disorder with CBT by Fiona Challacombe, Victoria Bream Oldfield and Paul Salkovskis, Vermillion.

More information and support

Maternal OCD is a charity that provides information about OCD during pregnancy and after birth

OCD Action is the largest UK charity focussing on OCD. They provide support and information. 

OCD-UK provides advice information and support to anyone affected by OCD.

MIND provide advice and support to empower anyone experiencing a mental health problem.