A new mother may constantly worry and check to see if her
baby is still breathing. Or she may fret about germs, obsessing whether she's
properly sterilised the bottles, then wash and rewash them.
A new Northwestern Medicine® study found that women who have
recently given birth have a much higher rate of obsessive-compulsive symptoms
than the general population.
The study found 11% of women at two weeks and six months
postpartum experience significant obsessive-compulsive symptoms compared to 2
to 3% in the general population. This is the first large-scale longitudinal
study of obsessive-compulsive symptoms in the postpartum period.
These symptoms, including fear of injuring the baby and
worry about germs, are usually temporary and could result from hormonal changes
or be an adaptive response to caring for a new baby, researchers said. But if
the compulsions interfere with a mother's functioning, they may indicate a
Some obsessions are
"It may be that certain kinds of obsessions and
compulsions are adaptive and appropriate for a new parent, for example those
about cleanliness and hygiene," said study senior author Dana Gossett,
M.D., chief and assistant professor of obstetrics and gynaecology at
Northwestern University Feinberg School of Medicine and a physician at
Northwestern Memorial Hospital. "But when it interferes with normal
day-to-day functioning and appropriate care for the baby and parent, it becomes
maladaptive and pathologic."
The study will be published the March/April issue of The Journal of Reproductive Medicine.
Gossett and colleagues' recollections of their own obsessive
and upsetting thoughts after giving birth led them to investigate if the
experience was universal.
Obsessions are unwanted and repeated thoughts or images that
"A compulsion is a response to those obsessive
thoughts, a ritualistic behaviour that temporary allays the anxiety but can't
rationally prevent the obsession from occurring," explained Emily Miller,
M.D., lead study author and a clinical fellow in maternal foetal medicine at
What triggers OCD?
Obsessive-compulsive disorder (OCD) may be triggered by
stress, research shows. Thus, stressful situations, such as pregnancy and the
postpartum period, may exacerbate or predispose women to OCD.
The most prevalent thoughts women reported in the study were
concern about dirt or germs followed by compulsions to check that they did not
"make a mistake," Miller said. New mothers may check and recheck baby
monitors are working, the baby's crib side is properly latched or bottles are
properly sterilized, for example.
Some women in the study reported intrusive thoughts that
they would harm the baby. "That can be emotionally painful," Miller
said. "You don't intend to harm the baby, but you're fearful that you
For postpartum women with obsessive-compulsive symptoms who
otherwise are functioning normally, Gossett said, "It would be reassuring
to hear that their thoughts and behaviors are very common and should
What’s normal and
Gossett recalled that after she gave birth to her first
child, she routinely worried about falling down the stairs with her baby or the
baby would fall out of bed. "It comes into your mind unbidden and it's
frightening," she said.
Researchers now need to determine what behaviour is normal
and what's pathologic, Gossett said.
The women in the study were recruited during their delivery
hospitalization at Northwestern Memorial and completed screening tests for
anxiety, depression and OCD two weeks and six months after going home. A total
of 461 women completed the surveys at two weeks and 329 of the original group
completed them at six months. The women's symptoms were self-reported and they
did not receive a clinical diagnosis by a psychologist.
About 50 percent of the women reported an improvement in
their symptoms by six months, but at that time point new women developed
symptoms whom had not experienced them at two weeks.
"If those symptoms are developing much later after
delivery, they are less likely to be hormonal or adaptive," Gossett said.
The risk for psychological disorders persists for up to a year after delivery,
About 70 percent of the women who screened positive for
obsessive-compulsive symptoms also screened positive for depression. That
overlap and the unique subset of obsessions and compulsions could indicate
postpartum OCD represents a distinct postpartum mental illness that is not well
classified, Miller said.
"There is some debate as to whether postpartum
depression is simply a major depressive episode that happens after birth or its
own disease with its own features," Miller said. "Our study supports
the idea that it may be its own disease with more of the anxiety and
obsessive-compulsive symptoms than would be typical for a major depressive