OCD “Came At Me Like A Ton Of Bricks” During Pregnancy

"I thought that when I had a baby, the OCD would all just magically disappear because I'd be so happy. When he was born, I realised... it's not a magic wand."

Katy is a 24-year-old stay-at-home mother from Milton Keynes who, when getting treatment for her eating disorder at 20, was also diagnosed with obsessive compulsive disorder (OCD). OCD is a mental health condition in which a person has obsessive thoughts and compulsive behaviours. It is estimated to affect 1.2% of the population at any one time, though that percentage could be far higher.

For many, OCD is not easy to recognise as the compulsions can be attributed to other mental health problems. Katy had assumed a lot of her behaviours were part of her eating disorder. "At that time, a lot of of my compulsions were around food and eating — if I felt that I had eaten too much, I would have to get rid of the food, clean everything and clean all the clothes that I wore when eating."

After a course of talking therapy and antidepressants for both the eating disorder and OCD, Katy now manages her mental health with the techniques she learned through therapy, as well as medication, when needed. "At the time that I got pregnant I had been off [medication] for about three or four months, which is the point I usually get bad again, and my mental health was the best it had been in years. I didn’t really feel like I had OCD at that point," she says. However, though she was delighted to find out she was pregnant, her mental health plummeted.

The stress of a bad relationship falling apart at the beginning of her pregnancy was traumatic for Katy, and changed the shape of her OCD. "I’d never really had fear-based obsessions before, but now I was very scared something bad was going to happen, that I’d lose the baby or do something wrong." This was compounded by the fact that medical professionals didn't know whether it was safe for her to stay on her medication. "I wasn't prepared to take the risk, so I willpowered my way through. My thinking was that if it gets really bad, I won't breastfeed and as soon as I give birth I'll go on antidepressants." Katy's old compulsions also came back in new forms. "I was so determined that I was going to eat well and be healthy in my pregnancy that instead of having compulsions based around food, they had to take on different angles. I got very perfectionist — the nursery had to be perfect and I would get really stressed and annoyed if it wasn't. [It was as though] if I made everything perfect, then it would be okay and I'd be able to be a good mum."

OCD during pregnancy and post-birth is known as perinatal OCD, a condition that can either be triggered by pregnancy or morph from pre-existing conditions once a person with OCD becomes pregnant. It is thought to affect 1% of people during pregnancy, and around 3% in the year following the birth. Some studies even suggest that specifically postnatal OCD is much more prevalent, at 4-9%. However, due to the shame that surrounds the disorder, particularly around intrusive and obsessive thoughts, there may be many suffering who do not seek help, meaning these numbers could be much higher.

According to the British Journal of General Practice, peri- and postnatal OCD's main areas of focus are fear of harm through contamination and related compulsions (excessive washing, restriction of diet, avoidance of activities and contact with others), and fear of deliberately harming or terrible things happening to the baby. In addition, as in Katy’s case, the Royal College of Psychiatrists notes perfectionism and doubting whether you did or did not do something you consider vital as key areas.

OCD, as sufferers know, is exhausting and can be exacerbated by big life events. This was one of the reasons why Maria Bavetta, cofounder of Maternal OCD, a charity that provides resources for people affected by perinatal OCD, waited five years to have her second child. Like Katy, she realised that she’d probably had OCD from a young age, but didn’t recognise how it would impact her first pregnancy. "It came at me like being hit by a ton of bricks. The decision to have another child is where I then had to consider my mental health. [At first] I wasn't well enough to have a second and then when I was, I wasn't sure if I had the strength to fight it again."

Given the huge life change of having a child, it is perhaps unsurprising that it is a time of enormous anxiety. Maria tells me: "The feeling of responsibility when you become a parent can sometimes feel overwhelming, and with perinatal OCD it felt like an impossible task — I used to think, How can I possibly be 100% responsible for the safety of this little vulnerable baby? How do other mothers cope with the pressure?"

In her first pregnancy, the compulsions became a way to cope. In trying to protect her daughter from any harm, Maria developed intensive cleaning rituals — "spending over an hour cleaning just three bottles before putting them in the steriliser" — and checking rituals — "acting as a health and safety officer for any type of germs when we went out." She would seek out possible risks and then avoid them by being obsessively careful about what she fed her daughter.

As Katy learned the hard way, the arrival of the baby doesn't necessarily mean a lessening of symptoms. Her initial plan of going back on antidepressants went out the window. "Within about five minutes of him being born, I realised I loved him so much and I needed to breastfeed him." For the first few weeks she was so happy and busy that the OCD was almost completely gone. "It sounds like a weird thing to say, I didn't have time for OCD. I was so busy with him and any spare time I had I was trying to sleep or clean up." Yet as he got older and she had more time, she could feel it coming back. "I didn't have the usual option of going on antidepressants, which scared me." Katy was acutely conscious that she didn't want to pass anything on to her son. "I wanted him to see me healthy and happy. So every time I found myself dipping, I reminded myself of that and that would help me push myself to challenge the compulsions."

Weirdly, she says, having a child actually made her cleaning compulsions better. "There was nothing I could do. There was one day where I had cleaned all my bedding, everything was all nice and fresh, and then the baby was just sick everywhere, all over me, all over the bedding. And I realised that I can't control this, there's nothing I can do. I had to surrender it all because I was fighting a losing battle. And it was actually really therapeutic — it challenged me in a really healthy way, which was a positive thing."

Support and planning is crucial for anyone with a mental health issue who is thinking about having a baby — both for the mother and the child. Maria only made the decision with her husband to try and conceive again "after lots of informed conversations between us about how I can put measures (personal and clinical) in place to support myself in case OCD came knocking again." As well as making sure that any healthcare professionals they see during their pregnancy know what they’re experiencing, Maria and her charity urge people in her position to make room for themselves.

"I know this can be difficult but it could simply be five minutes meditation, chocolate on the sofa, going for a walk (with baby in the pram) or putting an exercise DVD on — whatever will build your resistance up and give you energy, try and find time to do. Anything that depletes you that isn't essential, don't do it… Your wellbeing is paramount, everything else is second."

Katy echoes this. "The thing they always say [on planes] to parents is that you have to put your own oxygen mask on first — I'm gonna be of no use to him if I'm drowning in compulsions and losing myself to that. You have to prioritise your own mental health first, because you can't be a parent if you're falling apart yourself."

The community is another place to find support. Katy already had the invaluable support of her family, particularly her mum, but didn’t expect to find help through other new mothers. To her surprise, many shared their experience of mental health problems. "It's really shocked me how many have had mental health problems, not necessarily OCD, but they've had eating disorders or anxiety or depression. It's been a huge comfort to know that it's so, so common for it to happen to people, even to people who've not had problems beforehand, but they've had kids and suddenly developed problems. It's nice to know that you're all in it together."

Both Maria and Katy already had an understanding of how their OCD manifested and were able to put tools in place. Unfortunately this isn’t the case for many, especially if OCD has only been triggered by pregnancy. As the report from the British Journal of General Practice states: "Lack of awareness of perinatal OCD can lead to failure to diagnose, or misdiagnosis, and inappropriate treatment, which causes distress and potential disruption of mother-infant relationships." This is why the work of charities like Maternal OCD and OCD Action is so important; to ensure that perinatal OCD sufferers have the right tools to support themselves, medical professionals and new mothers alike must be given the right information, support and treatment with therapies like cognitive behavioural therapy.

Perinatal OCD doesn’t have to be a reason not to have a child. But it is important to seek and plan for the right treatment and support. Equally, it is important to forge support networks that understand and encourage us all to recognise that it is not a failing to put your own oxygen mask on first.