OCD in pregnancy: when the scary thoughts start before the baby arrives
If you or your partner are pregnant, you've probably already had more advice than you know what to do with, from the midwife, from your mum, and from a very confident stranger in the queue at the post office. What people don't tend to mention is that for some parents-to-be, pregnancy is also when OCD starts, or when OCD that was already there gets a lot louder.
I'm Charlotte, an OCD specialist therapist in the UK, and perinatal OCD has been a special interest of mine for around 8 years. I've written before about OCD after a baby arrives, and this post is about the months before, which get far less attention.
This one is personal for me too. My own OCD has been at its loudest in pregnancy and after having my children, so it's something I understand from the inside as well as from my work.
First, what's normal
Pregnancy can bring a lot of worry, and that makes sense. You're suddenly responsible for someone you haven't met yet, there are new rules about food and medication, and there's a lot you can't control. Worrying about the baby, reading up on what's safe, and checking in with your midwife when something feels off are all normal, caring parts of pregnancy. None of that on its own is OCD.
So when might it be OCD?
OCD is a cycle of obsessions (thoughts, images, urges or doubts that keep coming back, feel unwanted and cause real distress) and compulsions (things you do, out loud or in your head, to make the distress settle or to feel sure).
Clinicians usually start thinking about OCD when that cycle causes real distress, takes up a lot of time, often more than an hour a day, or gets in the way of daily life. Only a qualified professional can say whether it's OCD, so if this sounds familiar, it's worth asking rather than guessing.
How common is OCD in pregnancy?
More common than most people think. In a Canadian study that interviewed 763 women from late pregnancy into the months after birth, 7.8% had OCD at some point during the pregnancy part of the study, and around 2.9% at any one time (Fairbrother and colleagues, 2021). The researchers also found that when women were asked properly about pregnancy-specific worries, the numbers were higher than earlier studies had suggested.
For women who already had OCD, a study of 542 women found that 33% said it got worse during pregnancy, and around 5% said their OCD first started then (Guglielmi and colleagues, 2014). The same study found that if OCD got worse in a first pregnancy, it was more likely to happen again in the next one. That's really useful to know, because it means support can be planned in early for a next pregnancy.
NICE, which sets health guidance in England, recognises that anxiety disorders, OCD included, are under-recognised throughout pregnancy and after birth. So if you've been struggling quietly, that's very common, and it isn't a sign you've done anything wrong.
Most of the research so far has been with mums, but partners can experience OCD in pregnancy and after the baby arrives too, and everything in this post applies to them as well.
What it can look like in pregnancy
The thoughts are often about the baby, or about getting something wrong. They tend to land on exactly what you care about most, which is why they feel so upsetting. The compulsions can include:
checking and rechecking food labels, safety lists or medication leaflets, long after you've found the answer
going over things in your head to work out whether something you ate, did or touched could have caused harm
extra cleaning or avoiding things because of contamination worries
asking your midwife, partner or family the same question again and again, or searching online until it feels settled
avoiding things that set the thoughts off, like knives, baby items or conversations about the birth
trying to push the thought away, pray it away or "cancel it out" with another thought
Each of these brings a little relief, and that relief is exactly what teaches the brain the thought was dangerous, so it comes back louder.
One really important note. Some checking in pregnancy is exactly what you should be doing. If you notice your baby's movements slowing down or changing, or you're worried about any symptom, always contact your midwife or maternity unit straight away, any time of day or night. OCD treatment never asks you to ignore real medical advice. It focuses on the extra loops that go far beyond it.
Why it stays hidden
Many parents-to-be keep these thoughts to themselves, because they're frightened of what the thoughts might mean, or of what someone might think if they said them out loud. It can also be easy for everyone, you included, to put it down to "normal pregnancy nerves". So the OCD carries on quietly, often right up until the baby arrives.
You don't have to tell anyone the exact thought to get help. Saying "I'm having unwanted thoughts that are really frightening me, and I can't stop checking" is enough to start the conversation.
What helps
Perinatal OCD is a recognised condition with well-researched treatments, and recovery is possible. The treatment NICE recommends first is CBT with exposure and response prevention (ERP), adapted for pregnancy. We work together, at your pace, to understand your loop and gently practise dropping the compulsions, so the thoughts can start to lose their grip.
If you take medication for OCD or anxiety and you're pregnant or planning a pregnancy, please don't stop or change it on your own. Speak to your GP, midwife or perinatal mental health team, who can talk through the options with you.
I'm also building a course for parents and parents-to-be with scary thoughts in pregnancy and after a baby, coming in 2027.
Other places to find support
your midwife, GP or health visitor, who can refer you to perinatal mental health support
in England, NHS Talking Therapies, which you can refer yourself to
Maternal OCD (maternalocd.org), a UK charity for perinatal OCD
OCD-UK (ocduk.org), the national OCD charity
OCfree (ocfree.co.uk), the OCD support hub I co-founded with OCD therapist Jess Eden
I've also written about what can happen after birth here: Postpartum OCD
Quick answers
Tap a question to open it.
Do you work with perinatal OCD?
Yes. I work with parents and parents-to-be, from pregnancy planning through to after birth. Unwanted thoughts are very common in new parents, and when they start to take over, that can be perinatal OCD. It is a recognised condition with well-researched treatments.
What if I can't say my thoughts out loud?
That's very common, and we never start there. You can share as much or as little as you like, in your own time, and you can write things down if that's easier. Whatever you tell me, I won't be shocked.
Does CBT with ERP work for OCD?
CBT that includes Exposure and Response Prevention (ERP) is the treatment recommended for OCD in NICE guidance and by the NHS. Many people find their symptoms reduce with it. Everyone responds differently, so we review how it's going as we work.
Do I need a diagnosis or a GP referral?
No. You can contact me directly.
When you're ready
I work with parents and parents-to-be online across the UK, from pregnancy through to after birth. You don't need to have it all figured out, and you don't need to tell me the thought in your first message.
For bite-sized OCD support most days, come and find me on Instagram at @the_floral_therapist.
Charlotte
Research mentioned in this post
Fairbrother, N., et al. (2021). High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. Journal of Clinical Psychiatry, 82(2), 20m13398.
Guglielmi, V., Vulink, N. C. C., Denys, D., et al. (2014). Obsessive-compulsive disorder and female reproductive cycle events. Depression and Anxiety, 31(12), 979-987.
National Institute for Health and Care Excellence (2014, updated 2020). Antenatal and postnatal mental health: clinical management and service guidance (CG192).
If you feel unsafe, or worried you might act on a thought, call 999 or go to A&E, call NHS 111 and choose the mental health option, or call Samaritans free, any time, on 116 123. If you're pregnant or have recently had a baby and suddenly feel very unwell, confused or not like yourself, please contact your GP, midwife or health visitor today, or call 999.
This post is educational and isn't a replacement for therapy. Please speak to an OCD specialist or contact your GP for further support.
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