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Perinatal Obsessive
Compulsive Disorder



Have you had any of these distressing thoughts?

  • What if I throw the baby out the window?

  • What if I accidentally stab my baby?

  • What if I forget the baby in the car?

  • What if I give my baby a disease ?


These thoughts and images are scary enough as it is. If those weren’t enough, we find ourselves avoiding any potential situations or objects that may trigger these distressing thoughts. We may have to ask a loved one to repeatedly reassurance us that we won’t act on our thoughts. You may fear being alone with your baby, and count down the minutes until your partner is back home. Or, you may find an urge to engage in a compulsion, like checking and rechecking that the door is locked, to help ease your intense feelings of anxiety or panic.  Avoidance, repeatedly asking for reassurance, checking and rechecking or all examples of compulsions.


During pregnancy and postpartum periods, women may experience intrusive thoughts or images for the first time, or may have a resurgence of symptoms if there was a previous diagnosis of OCD.  Intrusive thoughts are often about accidental or intentional harm coming to the baby.  Obsessive thoughts can be violent or sexual in nature and are therefore deeply distressing when experienced.


It is crucial to understand the difference between Perinatal OCD and Postpartum Psychosis as symptoms may seem similar to a layperson. The OCD sufferer is severely distressed by these disturbing thoughts and his horrified at the thought of harm coming to her baby.  She is debilitated by these "ego-dystonic" obsessions (thoughts not lining up with the character or personality of a person). Women with postpartum psychosis do not experience concern over their disturbing thoughts.  They experience a break in reality where the thoughts make sense to them and they may think they are actually saving/helping their baby by engaging in the impulse. Postpartum psychosis requires a higher level of care and a brief hospital stay is usually required.


As a result of these obsessive thoughts, women may experience intense guilt-shame, isolation, panic attacks and crippling anxiety. In order to cope, it is common for sufferers to avoid triggering situations and to engage in certain rituals to help dispel the disturbing thoughts. Women may be frightened to tell their partner or medical provider about their thoughts for fear they will be labeled as "crazy," or worse, have their children removed.



  • Avoiding knives or sharp objects in the kitchen

  • Avoiding  dressing the baby or changing diapers due to fear of engaging in sexually inappropriate behavior           

  • Repeatedly asking for reassurance from friends/family members that the baby is safe and healthy

  • Repeatedly checking on the baby


Exposure And Response Prevention

Exposure and Response Prevention (ERP), a form of cognitive behavioral therapy, is an evidence-based treatment for obsessive compulsive symptoms. The exposure part of ERP means that you will be exposing yourself to situations, objects, thoughts, or images that trigger your obsessions and heightened anxiety. The response prevention part of ERP involves reducing the frequency of engaging in compulsive behavior that results from being triggered. While this process may initially sound anxiety provoking, rest assured that we will move through this process incrementally, safely, and with my support. As you become gradually exposed (whether through imaginal exposure or real-life situational exposure) you will find your anxiety decreasing.  Prior to starting ERP, we will spend some time learning effective coping strategies to help manage any anxiety that may surface during the process.

Acceptance and Commitment Therapy 

Acceptance and Commitment Therapy (ACT) is a branch of Cognitive Behavioral Therapy that encourages the acceptance of thoughts and feelings instead of fighting them. Applying the ACT theory and techniques have been shown to be extremely effective in reducing the distress that comes from obsessions, intrusive thoughts, and the urge to engage in compulsive behavior.  We will work together on shifting from over identifying with your thoughts to stepping back and acting as an observer to your thoughts and feelings. With ACT techniques, you will find that even if the thought still exists, you will not experience the emotional and physiological distress that once was associated with the obsessive or intrusive thought. Act tools are also extremely effective in other areas such as stress, depression, and overwhelm.

Do you find that you have trouble explaining this to your partner or loved one?

Do you feel that you need more support at home? You are certainly not alone in feeling this way! Intrusive thoughts and obsessions can be very hard for others to understand and they may struggle with not knowing how to best support you. If this sounds familiar, I welcome you to invite your partner or support person into a session. Your partner will leave with a greater understanding of the symptoms, challenges and different aspects of OCD.  They will be equipped with basic knowledge on how best to support you during your treatment. You may leave the session feeling more supported, understood, and heard.





What About Medication?

If needed, psychotropic medication, coupled with counseling, is the gold standard for OCD treatment. Medication does not mean you have failed, or can’t do it on your own. The addition of medication in treating OCD can be extraordinarily helpful. You deserve to feel better, and with the right treatment,  you will!

I don’t think I need therapy because these feelings will pass on their own.

In some cases, the emotional highs and lows can subside on their own. However, treatment with a trained professional gives you the opportunity to feel better sooner. You can also take the skills you acquire in session and use them for future challenges in your life.

I don’t have a budget for therapy.

I do accept United, Cigna and Aetna insurance plans. If you have another provider, please check to see to what extent they may cover out-of-network therapy. For those not covered by insurance, or without it, I also accept self-pay. Maternal mental health is one aspect of pregnancy that is easy to ignore but that is so crucial to the foundation-building of a mother or parent partner. Making an investment to care for your mental health can benefit everyone in your home.

Interested in Perinatal OCD Treatment?  

If so, please contact me for a free consultation. My office is physically in Winter Park, Florida (Orlando)  I am licensed to provide online counseling services to anyone who resides in the state of Florida.

Your maternal mental health matters. Please reach out soon.


More About Sarah Courech, LMHC PMH-C

Sarah is a Licensed Mental Health Counselor, Certified Perinatal Mental

Health Professional and Owner of Moms in Mind Perinatal Counseling. She has expertise in treating mood and anxiety disorders during pregnancy and the postpartum period. Sarah helps new mothers cope with the transition to motherhood and successfully work through challenges that may arise during the early years. As a maternal mental health advocate and mother herself, Sarah understands the specific challenges women may experience during this life stage. Sarah proudly serves on the Board of The Tough Tough Fund, is a member of Central Florida Postpartum Alliance, Postpartum Support International, and the Mental Health Association of Central Florida 

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