Week One: Answers to your Questions about Postpartum

 
Totum Women Dr. Stephanie Canale

Most questions we received this week were related to Postpartum OCD (ppOCD), so our brilliant and kind Dr. Michelle expounds on the topic here.  

Postpartum OCD (ppOCD) is an anxiety disorder characterized by intrusive, unwanted, and repetitive thoughts, images, or urges (obsessions), which may or may not be accompanied by compulsive behaviors. While the exact cause of ppOCD is unknown, experts believe that it results from a combination of hormonal, psychological, genetic, biological, psychosocial, and environmental factors. Obsessions and compulsions can take many forms for different people and usually focus on the baby.

Obsessional thoughts might include:

  • I’m terrified my baby will get sick and die.

  • What if my baby stops breathing in the middle of the night?

  • I’m scared someone will steal my baby if we go out in public.

  • What if I accidentally or intentionally act on an urge to stab my baby?

  • Why do I keep having an image of my baby falling off the changing table?

Compulsions can include:

  • Repeatedly checking on the baby’s breathing in the middle of the night

  • Excessive bathing and washing rituals

  • Repeatedly asking others for reassurance that baby is okay

  • Taking great measures to avoid the baby

Obsessions are unwanted, difficult to control, and increase anxiety. In order to neutralize the anxiety associated with these obsessions, one might then engage in overt or mental compulsions or avoidance. For example, a mother might have repetitive images of something terrible happening to her baby while driving in the car. As a means to decrease the anxiety associated with this thought, she may avoid driving anywhere with her baby. Another mother might have unwanted thoughts that she will act on an urge to intentionally harm her own baby.  This mother might then begin to avoid her baby altogether. It is important to understand that in the latter example, this mother does not have these thoughts because she actually wants to hurt her child, but rather she is terrified that she might act on these thoughts. The obsessions are unwanted and conflict with a person's self-image and character.

According to the International OCD Foundation, up to 80% of new mothers report having strange, unwanted thoughts. This means that most new parents have similar experiences with anxiety and intrusive thoughts, but would not be diagnosed with Postpartum OCD. A diagnosis of OCD might be made when preoccupation with the intrusive thoughts is clearly disruptive to a mother’s normal functioning and greatly interferes with her ability to care for herself and her baby. It is no surprise that this can have devastating effects on the parent-child relationship and highlights the immense need for treatment. Due to the fear of stigma and feelings of intense shame, however many women are resistant to seeking help. If you or anyone you know is experiencing these symptoms please know that you are not alone and it is okay (and important) to reach out for help from a qualified and licensed mental health professional.

Others of you wanted to learn a little more about psychological and emotional responses to weaning. Dr. Michelle responds here: 

It is not uncommon for women to feel tearful, depressed, irritable, or anxious when weaning. Not much research exists on this topic, but some hypothesize that a shift in hormones when weaning may be a major cause for these feelings. Other factors might involve feelings of sadness around the loss of this special time with your infant. These mood changes usually go away on their own, but some weaning mothers may experience more severe symptoms that require treatment.