When is it More Than "Normal Mom Worry?": Perinatal Anxiety and OCD

Written By Ben Eckstein

Written by Allie Lieber

The perinatal period, spanning pregnancy through the first year postpartum, is a time of profound psychological and physiological change. Some degree of worry during this transition is not only common, it's adaptive. Your nervous system is recalibrating to meet the responsibility of keeping your new baby safe. However, there are times when this protective system becomes overactivated. When worry shifts from expected adjustment to persistent distress, additional support may be needed. In this article, we'll discuss how to identify when typical postpartum stress starts to look more like clinical anxiety or OCD.

What Is Considered “Normal”?

New and expecting moms often experience a sense of heightened vigilance. You might find yourself checking the baby monitor to make sure your baby is breathing, researching and searching for reassurance late at night, or replaying a conversation with your OB or pediatrician. This kind of worry, fatigue, and heightened alertness is common.  However, the worry typically:

  • Fluctuates rather than feeling constant

  • Does not significantly impair functioning or sleep (most of the time)

  • Responds, at least partially, to reassurance and logic

  • Is proportionate to a specific, identifiable concern

It's Something More: Perinatal Anxiety

Perinatal anxiety affects roughly 20% of perinatal women. While postpartum depression has received more attention, perinatal anxiety is roughly as common, yet often underrecognized. Here are some signs to help identify perinatal anxiety:

  • Persistent, excessive, and difficult-to-control worry

  • Racing thoughts that make it hard to sleep even when the baby is sleeping

  • Physical symptoms such as a rapid heartbeat, muscle tension, or nausea

  • Avoidance of certain situations or activities

  • A pervasive sense of impending harm coming to you or your baby

Rather than waxing and waning, the anxiety may feel relentless. 

“What if” It’s Something More: Perinatal OCD

Perinatal OCD is much less understood.  While OCD affects 1-2% of the general population, its prevalence is higher amongst perinatal women and subclinical intrusive symptoms are even more common. It is characterized by repetitive, intrusive thoughts or images and associated mental or physical behaviors to relieve the anxiety caused by these thoughts.  

These thoughts are often related to the pregnancy and the baby.  Sometimes moms can have scary thoughts about harming their baby. These thoughts are ego-dystonic, meaning they feel deeply inconsistent with who the mom is and what she would ever want to happen. That’s why these thoughts are so distressing. Perinatal OCD can also be the emergence or worsening of OCD symptoms during the perinatal period, in which case it can present with a range of other OCD themes such as health anxiety, cleanliness, and more.

Signs of perinatal OCD include:

  • Repetitive, unwanted, intrusive "what if" thoughts 

  • Avoiding certain objects (knives, stairs, bathtubs) out of fear

  • Excessive checking behaviors such as repeatedly checking breathing, temperature, locks

  • Seeking repeated reassurance from a partner or doctor that does not bring lasting relief

  • Feeling ashamed and hiding your thoughts from others

If any of this sounds familiar, please know: these thoughts do not make you a bad mom. They are symptoms of a treatable condition.

When to Reach Out

Some amount of worrying is adaptive and functional. But suffering in silence, or white-knuckling through intrusive thoughts alone, is not a requirement of motherhood. You deserve support, not just your baby. Reach out to a provider if your anxiety or intrusive thoughts are:

  • Interfering with your sleep, relationships, or ability to care for yourself or your baby

  • Causing you significant distress or shame

  • Leading you to avoid people, places, or activities

  • Getting worse rather than better over time

Effective Treatments Exist

Cognitive Behavioral Therapy (CBT) and a specific approach called Exposure and Response Prevention (ERP) are highly effective for both perinatal anxiety and OCD. Medication is also an option and can be safe during pregnancy and breastfeeding. Your provider can help you weigh the options.  

Perinatal anxiety and OCD are manageable and treatable conditions.

At Bull City Anxiety and OCD we have providers that are trained in both evidence-based treatments for OCD as well as special considerations for the perinatal population.  We also offer supplemental treatment programs for perinatal women and moms of young children to learn together and support one another through their journeys.  The Perinatal Anxiety & OCD Treatment Group meets on Tuesdays at 12pm. We hope you will join us here.

If you're in crisis or need immediate support, contact the Postpartum Support International helpline at 1-800-944-4773 or text "HELLO" to 220-25.

Ben Eckstein
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Perinatal Anxiety & OCD Treatment Group