Perinatal OCD: The Silent Struggle of New and Expecting Moms
Motherhood is often painted as a time of pure joy, but for some women, it brings an unexpected and distressing struggle—perinatal obsessive-compulsive disorder (OCD). While most people are familiar with postpartum depression, perinatal OCD remains less talked about, even though it can be just as overwhelming.
How Common Is Perinatal OCD?
Anxiety during pregnancy and postpartum is surprisingly common, affecting about 1 in 5 women. When it comes to OCD specifically, the numbers fluctuate throughout pregnancy and after birth:
First trimester: Rare (0%)
Second trimester: 0.5%
Third trimester: 3.5%
Postpartum: 2.4%–11%
For women who already have OCD, 17% experience worsening symptoms during pregnancy or after giving birth.
Why Does It Happen?
The causes of perinatal OCD are complex. A mix of hormonal shifts, genetics, sleep deprivation, and environmental stressors all play a role. Changes in oxytocin (the "bonding hormone") and serotonin levels may contribute, while severe lack of sleep can trigger or worsen symptoms. Some research even suggests that inflammation in the brain due to sleep disturbance could be a factor.
What Does Perinatal OCD Look Like?
Most moms with perinatal OCD experience intense intrusive thoughts—often terrifying images or ideas that they might harm their baby. These thoughts are unwanted, distressing, and completely out of character for the mother experiencing them. To cope, many engage in compulsions like:
Repeatedly checking on the baby to ensure they’re breathing
Excessive handwashing or sterilizing objects
Avoiding being alone with their baby out of fear of acting on an intrusive thought
Many mothers suffer in silence because they fear judgment or worry that others will see them as dangerous. In reality, women with perinatal OCD are not at risk of harming their babies—these thoughts are driven by fear, not intent.
Other Mental Health Conditions That May Coexist
OCD rarely comes alone. Up to 70% of moms with perinatal OCD also have a mood disorder like depression or generalized anxiety disorder. Some may also have personality traits associated with obsessive-compulsive, avoidant, or dependent personality disorders.
How Is It Diagnosed?
Early screening is crucial, especially for women with a history of depression, anxiety, or OCD. Clinicians may use the Perinatal Obsessive-Compulsive Scale (POCS), the only tool specifically designed for perinatal OCD. The widely used Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) can also assess severity, though it hasn’t been validated for postpartum cases.
What Can Help?
The good news is that perinatal OCD is highly treatable. First-line treatments include:
Cognitive Behavioral Therapy (CBT) – Particularly Exposure and Response Prevention (ERP), which helps retrain the brain to tolerate intrusive thoughts without engaging in compulsions.
Medication – This can be discussed with your midwife, nurse practitioner, and/or Doctor, this is not medical advice but know that selective serotonin reuptake inhibitors (SSRIs) are the safest antidepressants for pregnancy and breastfeeding. They pass into breast milk in low concentrations and are generally considered safe.
If you’re struggling, know this: You are not alone, and you are not a bad mother. Perinatal OCD is real, and help is available. The sooner it’s recognized and treated, the sooner you can get back to enjoying the journey of motherhood.
Jocelyn Gates RSW - guest blogger
Percudani, M., Bramante, A., Brenna, V., Pariante, C., Springer Science+Business Media, publisher, & SpringerLink. (2022). Key Topics in Perinatal Mental Health: Chapter 5 “Obsessive Compulsive Disorders” (M. Percudani, A. Bramante, V. Brenna, & C. Pariante, Eds.; First edition.). Springer International Publishing.
