After Liz Hughes gave birth in 2020, she noticed she worried a lot about his health.
“I developed this hyperawareness and sensitivity to his well being and I wasn’t sleeping. I would lay awake and monitor his breathing,” Hughes, 35, from Houston, tells TODAY.com. “You can’t stop yourself from going down this path of the worst-case scenario (for) every little thing.”
At a pediatrician’s visit, Hughes took a screening test for postpartum depression and anxiety. She had both, including postpartum OCD.
“The OCD, which is intrusive thoughts, and (it’s) like its own category,” she says.
Unusual pregnancy, birth complications and overwhelming thoughts
Hughes learned she was pregnant during the early days of the COVID-19 pandemic. With so much uncertainty, she didn’t know if her husband could be in the room with her when she delivered on December 29, 2020. That's when the worrying started.
“I was focusing so much on what to expect for labor and delivery and then trying to navigate the pandemic that I was not prepared at all for what comes after,” she says.
Then Hughes experienced a difficult labor.
“I hemorrhaged, which a lot of blood loss is conveniently linked to postpartum depression and anxiety,” she says. “I don’t know if that played a factor or if I always going to be at risk.”
What’s more, she learned she had been exposed to COVID-19 days before delivery and was isolated to prevent potential spread. No one came into her room, leaving food outside, and her son didn’t undergo normal procedures and tests, such as a hearing exam or circumcision.
“We had this really pretty terrible birth story,” she says. “It was supposed to be really joyful.”
When the family left the hospital, they were told to wear masks around the baby for two weeks and undergo COVID-19 testing every three days. Soon after, Hughes became hyper-vigilant about her son’s health.
“We bought the Owlet, which was like a sock that you put on their foot that monitors their heart rates and it links to the phone,” she says. “I have the Nanit, which is like a breathing band you put on them. And we didn’t have anyone around coming to visit because it was COVID.” Hughes constantly felt worried.
“Of course, not sleeping can make your brain really sick, especially with the mix of the hormones and postpartum,” she says. “Again, I thought this was normal when you had your first baby.”
At her six-week follow-up appointment, Hughes' doctor asked questions about how she was feeling mentally and whether she was sleeping. Hughes admitted she wasn’t sleeping well but the staff reassured her that’s normal with a new baby. Still, the intrusive thoughts worsened. When she went to one of her son’s pediatrician appointment’s, she took a survey evaluating her mental health.
“I had failed this,” Hughes says. “(The doctor) said, ‘So how are you feeling.’ And I just completely lost it, burst into tears and that’s when she was like, ‘Look, I think you might be experiencing postpartum depression and anxiety.’”
Her son’s pediatrician recommended that Hughes visit a provider at the Texas Children’s Pavilion for Women. She was diagnosed with postpartum depression, anxiety and OCD.
“It was hard,” she says. “I feel like it went on for a long time before it got caught.”
While perinatal mood and anxiety disorders occur frequently, it can be difficult for new parents to understand how much anxiety is normal and when it becomes problematic.
“About one in seven women experience perinatal mood and anxiety disorders,” Dr. Nicole H. Cirino, a reproductive psychiatrist at Texas Children’s Pavilion for Women, tells TODAY.com. “Most common are disorders with the anxiety component. Even our classic condition of postpartum depression that most people are familiar with has a fair significant component of anxiety that goes with it.”
Some patients develop OCD, intrusive thoughts that people feel they must act on with a ritual behavior.
“Some amount of increased anxiety we would say is a normal part of evolution during pregnancy and postpartum,” Cirino says.
She says it’s normal for people to worry about dangers to their babies or double checking if they fed their babies. If someone has postpartum OCD their thoughts would feel intrusive.
“The incidence of obsessive compulsive disorder is quite significantly increased during the perinatal period,” Cirino says. “In the general population for women we would put the incidence (of OCD) at one or two per 100. In the perinatal period that’s about four to 11 women (per 100) during pregnancy or postpartum would experience a perinatal surge of obsessive compulsive disorder.”
She says most often people with perinatal OCD feel consumed by thoughts related to safety of pregnancy and the baby.
“Obsessions are defined as unwanted intrusive thoughts, impulse or images or even sensations that occur,” Cirino says. “What happens in obsessive compulsive disorder is the concern that comes up, like ‘I might trip,’ which goes into ‘I might trip holding the baby’ and then sometimes your brain would then start to picture what could happen if you fell holding your brand new baby even though you haven’t fallen yet.”
That fear might pop up every time a mom holds her baby so then she might consider taking a compulsive action — replacing the rugs, only sitting while holding the baby or not holding the baby at all — to try to fix the intrusive thoughts.
“(They) can’t suppress (the intrusive thoughts) as you normally would be able to and they keep coming back and getting strong,” Cirino says.
While the postpartum period ideally should be a time for moms to heal physically and mentally, that’s not the reality for most.
“They’re sleep deprived. Often too anxious to eat. Often are having to take care of both themselves (and the baby), have limited support, trying to navigate breastfeeding, trying to navigate the thought of them going back to work in a few weeks or months,” Cirino says. “There is a tremendous amount of stress on women, particularly in the US, without the support they need, and that is the origin of the problem.”
People with mothers or grandmothers who experienced postpartum mood and anxiety disorders are more likely to experience them, too. Women with PMS, PMDD, are “particularly sensitive to hormonal shifts,” had a difficult pregnancy or delivery are also at greater risk of developing postpartum mood and anxiety disorders.
The good news: There are treatments that work, including medicine and therapy.
“It’s a combination of psychoeducation — where you’re explaining what’s happening to them so they can understand why their brain is doing this — as well as support … and then some self-care, where we want them eating regular meals, sleeping, increasing their support,” she says. “Psychotherapy techniques helps them be able to manage the intrusive images and the compulsion and medication, depending on the severity.”
Hughes took medication and attended therapy to treat her postpartum OCD. When she became pregnant again, she made an appointment for treatment before giving birth.
“I read a statistic somewhere that it turned out that 80% of people that experience it the first time, it’s going to recur with an addition pregnancy,” she says. “I had a really rough second pregnancy. I threw up every day. I was on blood thinners. It’s also watching a toddler and working.”
Her second delivery went well on November 5, 2022. She thought she might have “escaped the dreaded postpartum depression, anxiety.” Around six weeks after birth though, things changed.
“I went from that bliss of having a newborn,” she says. “I wasn’t sleeping really well and I started having those intrusive thoughts coming back.”
This time she met with Cirino, who helped her navigate treatment.
“I couldn’t have asked for a better experience when you’re going through something as traumatic as postpartum depression (and OCD),” Hughes says. “I just had that cloud lift, if you will, like maybe the last two or three weeks. It took me a little while to get to feeling like myself again.”
She will receive treatment for up to a year postpartum.
“I’ll see how I’m feeling after a year. I’ll go through my transition back to working by then, where you can experience a dip in mental health as you adjust back to your working life with your kids,” she says. “There’s a little bit higher risk if you get that OCD component that maybe doesn’t fully resolve.”
Hughes shares her story to help others experiencing postpartum OCD.
“There are days where you’re thinking, ‘Am I going to feel like this forever,’” she says. “I hope that people get help and they read this and say, ‘Oh, there’s a light at the end of the tunnel.’”