Postpartum

The first months after birth are filled with many new and important baby-related tasks and broken sleep patterns – a stressful combination for most. Parenting can be overwhelming, and teary moments are common, but most parents and care providers are on the lookout for moods that swing too low or hang on for too long. Postpartum depression is on just about everyone’s radar nowadays.
Santa Cruz County’s Perinatal Mental Health Coalition (PMHC) provides information and support to parents, and those who work with parents, around mental health and wellness in the childbearing years. Their website SpeakUpSantaCruz.org provides families and professionals with local information for referrals, as well as links to the amazing resources of Postpartum Support International.

Part of the PMHC outreach during Mental Health Month this May, included a continuing education presentation to members about a specific aspect of Postpartum Depression/Postpartum Mood Disorders known as Postpartum Obsessive-Compulsive Disorder or pOCD.

While mental health assessments are taking place at prenatal, postpartum, and well-baby visits to screen for depression, signs of pOCD can be harder to recognize for both the provider and the parent. There are similarities to “regular” OCD where we think of excessive hand washing, checking the burners on the stove etc., but pOCD is a little different.

• Obsessive (intrusive) thoughts or images can begin suddenly. These thoughts or images that feel very out of character might be sexual or violent in nature or focus on sanitizing germs or other worries. These thoughts feel horrifying to the person experiencing them.
• Compulsive thoughts or actions are then performed to try to control or balance the anxiety caused by the obsessive thoughts or images. Repetitive hand washing is more obvious, but compulsivity might look like following rigid rules, checking for signs of harm, avoiding being with the baby, over researching, or seeking reassurance.
• Disorder means it is life disrupting. Most will need help to bring things back into order.

While just about every new mother has had an occasional bizarre or scary thought – fear of dropping, hurting, or in some way endangering their baby – most of these thoughts are fleeting. But for a small percentage of new mothers, these thoughts or images can feel very intense and disturbing, especially as they begin to persist and intrude on normal thoughts and behaviors.

pOCD can be harder to recognize because the compulsive behaviors may not be notable without knowing that it’s being done in response to intrusive thoughts. What can look like the behavior of any nervous new mother can be masking the panic of someone trying to deal with a horrifying inner dialogue.

A normally competent person can be in utter disbelief that this is happening to them. Healthcare professionals who experienced pOCD themselves and had a hard time recognizing and seeking treatment for it, shine a light on the difficulty parents can face including undue pain and delay in seeking help. Good people – really, amazingly wonderful parents – can develop pOCD and not know that it’s happening.

Intrusive thoughts or images that persist become more and more problematic. Often the thoughts are so awful the idea of telling someone about them can feel just as scary as the thoughts themselves. A mother might think, “What if they take my baby away or lock me up in a psych ward?” Postpartum psychosis is rare and involves dangerous thoughts that make sense to the parent who feels compelled to carry them out. Psychosis is an emergency that needs immediate intervention. pOCD is different from psychosis in that pOCD thoughts are generally appalling to the parent who then enlists compulsive thoughts and actions to relieve the anxiety brought on by the offending thoughts. Thoughts and feelings are not actions. pOCD does need to be assessed and treated in order to heal.

Untreated, pOCD can result in:

• 
  Baby care and feeding problems caused by avoidance of touching, being responsible for, or being alone with the baby.
• Relationship stress caused by extreme anxiety.
• Problems bonding due to avoiding the baby or baby related tasks.
• Signs of depression such as sadness, loss of interest in people and activities, sleep loss or excessive sleepiness, loss of appetite, suicidal thinking, hopelessness, helplessness, and lack of self-care.

There are medications and treatments that can reduce pOCD symptoms. Understanding the issue is the first step for parents, as well as care providers. Finding knowledgeable counselors offering treatment can be a challenge, but the PMHC is helping to bring awareness and resources to this often-hidden form of postpartum mood disorder.

Resources and Support -SpeakUpSantaCruz.orghttp://SpeakUpSantaCruz.org
Prenatal/postpartum support – Birthnet.org
Wednesdays 5:30pm online pOCD support group http://bit.ly/FindSupportGroup
pOCD Handout –
https://iocdf.org/wp-content/uploads/2014/09/Postpartum-and-Perinatal-OCD.pdf