Perinatal OCD: When Pregnancy and New Motherhood Feel Nothing Like You Expected
You expected to feel joy. Maybe some exhaustion, some nerves — but definitely joy. Instead, your mind is running a loop you can't turn off. Thoughts you'd never act on. Fears about your baby that feel shameful to even admit. A creeping certainty that something terrible will happen if you don't check, clean, pray, or ask for reassurance one more time.
This is not a reflection of who you are as a mother. It is not a sign that you are dangerous, impure, or failing. It has a name — perinatal OCD — and it is far more common than anyone talks about.
What Is Perinatal OCD?
Perinatal OCD is obsessive-compulsive disorder that emerges or intensifies during pregnancy or the postpartum period. The hormonal shifts, sleep deprivation, and profound identity changes of new parenthood can activate or amplify OCD in women who may have had no prior symptoms — or bring back OCD that had been quiet for years.
It is frequently misdiagnosed as postpartum depression or postpartum anxiety, which means many women spend months in the wrong treatment, wondering why nothing is helping. The distinction matters — because OCD has a specific treatment, and general anxiety approaches often don't touch it.
What It Actually Looks Like
Perinatal OCD doesn't always look the way people expect. It rarely looks like the stereotypes. Here's what it more commonly looks like in the women I work with:
Contamination fears centered on the baby. An overwhelming fear that the baby will be exposed to germs, illness, or harm through contact — with you, with visitors, with surfaces, with the outside world. What begins as reasonable caution can quietly become an exhausting system of rules, rituals, and avoidance that controls the entire household. The baby's bottle must be cleaned a certain way. Visitors must follow specific protocols. Leaving the house feels like running a gauntlet.
Checking and reassurance-seeking that never quite works. Checking that the baby is breathing. Asking your partner if they think the baby is okay. Googling symptoms at 2am and feeling briefly calm — before the next thought arrives. Calling the pediatrician more than you know you should. The reassurance brings relief for a moment, and then the doubt floods back, louder than before. This is the OCD cycle doing exactly what it does.
Fear of being a bad or sinful mother. Intrusive thoughts — about your worth as a mother, about whether you love your baby enough, about whether God sees you as failing — that you can't shake no matter how much you pray, confess, or seek reassurance from others. For women of faith, these thoughts can be especially tormenting, carrying the additional weight of spiritual shame. The thoughts feel like evidence of something broken inside you. They are not. They are OCD wearing a particularly painful mask.
What Makes Perinatal OCD Different From "Normal" New Parent Worries
Every new parent worries. Worry about a baby's safety is not only normal — it's biological. The difference with OCD is the cycle.
With typical new-parent anxiety, a worry arises, you take reasonable action or reassure yourself, and it passes. With OCD, the thought arrives and triggers a compulsion — checking, cleaning, confessing, seeking reassurance — and the relief is real but fleeting. Within minutes or hours, the thought returns with the same urgency. The compulsion has to happen again. The loop runs on a shorter and shorter cycle until it is consuming hours of your day and making it impossible to be present with your baby, your partner, or yourself.
If you recognize this pattern — if the relief never quite lasts, if the checking or reassuring or avoiding is growing rather than shrinking — that is important information. It is not a willpower problem. It is OCD, and it responds to a specific kind of help.
A Note for Women of Faith
For some women, perinatal OCD arrives with a deeply religious texture. Intrusive thoughts about spiritual impurity, fear of sinning through thought or action, compulsive praying or confessing, seeking reassurance from clergy or scripture — and still the doubt remains.
This intersection of faith and OCD is something I work with often. The shame it carries can be profound, and it is frequently misunderstood even within communities of faith. It does not mean your faith is weak. It does not mean the thoughts are true. It means OCD has found the thing you care about most — your faith, your relationship with God, your sense of yourself as a good mother — and made it its territory.
There is a name for this: scrupulosity. I write about it in more depth here. [link placeholder]
How ERP Helps
ERP — Exposure and Response Prevention — is the gold-standard treatment for OCD, including its perinatal presentation. Rather than trying to eliminate or suppress the intrusive thoughts, ERP works by changing your relationship to them. You learn to meet the thought with awareness rather than alarm, to resist the compulsive response, and to let the discomfort pass without acting on it.
For perinatal OCD specifically, this might look like:
Practicing sitting with the uncertainty that the baby might be exposed to germs, without running through a cleaning ritual
Resisting the urge to check the monitor for a set period of time, and learning that you can tolerate that discomfort
Sitting with a fear-inducing thought about your worth as a mother without seeking reassurance — from your partner, from God, from yourself — and discovering that the thought loses power when it stops being answered
This work is done carefully and collaboratively. Nothing happens at a pace you haven't agreed to. And it is paired with ACT — Acceptance and Commitment Therapy — which helps you stay anchored to your values as a mother even while the hard work of ERP is underway.
Alongside the exposures, we build real skills — not coping strategies that manage symptoms, but capacities that change how you relate to your own mind. You learn to notice a thought without immediately reacting to it. To feel an emotion fully without being swept away by it. To recognize when fear is making the decisions and choose, deliberately, to act from your values instead. What kind of mother do you want to be? What does that look like today, in this moment, with the anxiety still present?
These are not abstract ideas. They become tools you carry into every feeding, every sleepless night, every moment OCD tries to run the show. You don't have to wait until the OCD is gone to be present with your baby, your faith, or yourself. You can learn to act from what matters most to you even while the discomfort is still there.
You Are Not a Bad Mother
This is worth saying plainly: the presence of intrusive thoughts does not make you dangerous. It does not make you a bad mother, an impure person, or someone who cannot be trusted with her child. Research is consistent on this — people with OCD are not more likely to act on intrusive thoughts. The horror you feel at the thought is evidence of how much you love your baby and how deeply you hold your values.
What the thoughts are telling you and what is true about you are not the same thing.
Working With Tonya Swartzendruber
I'm Tonya Swartzendruber, and perinatal OCD is one of the presentations I work with most — including the religious and scrupulosity dimensions that often accompany it. If you're pregnant or postpartum and what you're reading here sounds familiar, please don't wait. The earlier OCD is addressed with the right treatment, the faster the cycle can be interrupted.
A free 15-minute consultation is a low-stakes place to start. You can ask questions, share what you're experiencing, and we can talk about whether working together makes sense.
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