Postpartum Mental Health: OCD and Psychosis

Sometimes after birth we don’t feel like ourselves, but eventually those feelings resolve. For some women, their postpartum time is filled with anxiety and compulsions, racing thoughts and sometimes voices in their heads, hallucinations and even violent behaviors. How are these conditions diagnosed? And what kind of impact can it have on the entire family?

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Newbies
Postpartum Mental Health: OCD and Psychosis

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

Dr. ALISON REMINICK: Sometimes after birth, we perhaps don’t feel like ourselves, but eventually those feelings resolve. For some women their postpartum time is filled with anxiety and compulsions, racing thoughts and sometimes voices in their heads, hallucinations, and even violent behaviors. Today we’re learning how to recognize Postpartum Obsessive Compulsive Disorder and Postpartum Psychosis. This is Newbies.

[Intro/Theme Music]

KRISTEN STRATTON: Welcome to Newbies! Newbies is your online, on-the-go support group, guiding new mothers through their baby's first year. I’m your host, Kristen Stratton, I’m a certified birth doula, a postpartum doula, and owner of In Due Season Doula Services. If you haven’t already, be sure to visit our website at www.newmommymedia.com and subscribe to our weekly newsletter. You can also subscribe to our show through iTunes, so you automatically get new shows when they’re released. Sunny’s here to tell us about other ways that you can participate in our new show.

SUNNY GAULT: All right, so we have changed the way that we are recording Newbies. Actually, we’re recording all of our shows for New Mommy Media and we hope that this allows everybody that wants to be part of the show to be part of the show. So, instead of recording in the studio environment in San Diego, we are now broadcasting, if you will, broadcasting or at least recording from our own home computers or work computers, but at our own individual locations.

So, you know what that means? That means you no longer have to get a babysitter and go to the studio or call in the various ways that we were recording previously. So hopefully this makes it easier for everyone to participate. So if that is a change for you that totally opens up the possibility of you being on a show, we would love to have you on a show.

The best thing to do is go to www.newmommymedia.com and we do have some banners and stuff up on the site that promote the fact that we’ve changed the way we record and now you can be part of it. So, click on that banner, there’s an online form that you can fill up which just gives our producers a little bit more information about you, so we can reach out to you when we have episodes that we think that you’d be a good fit for.

The other thing you can do is directly on that page, you can also join our Facebook group, which is awesome too, because that’s where we post all of our recordings, all of our topics, all of the times and that’s another great way for you to be proactive and say “hey, I’d really like to participate in this episode”.
So, be sure to go to our website at www.newmommymedia.com and check it out.

KRISTEN STRATTON All right. Let’s meet our panelists.

LEAH GROVER: My name is Leah Grover, I’m 31 years old, I’m a writer and stay-at-home mom to three girls, twins, aged six and a three-year-old and that’s me.

GRAEME SEABROOK: Hi. I’m Graeme Seabrook. I have two kids. Andrew is two and a half and Eleanor is four months old right now. I work from home in real estate and I also run a couple of support groups for moms dealing with maternal mental illnesses. So it’s postpartum depression, anxiety, OCD, PTSD psychosis. One is online and one is in person. And that’s me.

KRISTEN STRATTON: Thank you. Welcome to the show.

[Theme Music]

SUNNY GAULT: All right. So before we kick off our episode today and kind of get into the heart of what our episode is focusing on, I would like to share a headline. It’s actually a video but it kind of falls into our news headline segment and this is amazing. The title of it is “First breath of baby born inside amniotic sac caught on camera”. So, a baby was born, still inside the amniotic sac, which obviously this is a little bit different. The only thing I can compare this to, honestly, is when I was a little girl, one of our cats gave birth and I got to see babies come out, you know, kittens, whatever, being born still inside the sac. And that sort kind of reminded me I’ve never seen a baby still in the amniotic sac.

I feel like most of the times here in the US at least we break that water pretty quick, or you know, the sac is broken just naturally. Right? So, I’ve never seen anything like this and I’m not really 100% sure why the baby came out this way. But it’s an absolutely amazing video, it was shared on Facebook, but the mother I believe was sharing it, Jasmine Perez. And it’s absolutely amazing. I think last time I checked it had, let’s see, it has over 24 million views on Facebook, guys.

So this is like…I’m sure that’s not just in the US. People are watching this from all over the place and it’s absolutely amazing. The video shows the baby coming out and still in the sac, still just functioning completely perfectly, and then the doctors open up the sac and take the baby out and then the baby starts to breathe on its own. And this is just absolutely amazing to me but I wanted to get other people, you know, your perspective on this, to see, what you guys thought. So, Kristen, did you have a chance to look at the video? This thing is amazing.

KRISTEN STRATTON: Yes. Okay. So, this is kind of every birth worker’s dream, to see a baby born in whole, that’s what they call it. And yeah, I mean I saw that video and first I was a little fascinated because it actually looks like a cesarean birth.

SUNNY GAULT: Yeah, because they are already in their scrubs and stuff like that. Is that?

KRISTEN STRATTON: Yeah. So, I’m actually really surprised that it looks that way, but I couldn’t see on the article if it specified if it was a vaginal birth or not because it kind of looked like it wasn’t, but maybe they just like put the baby on a table or something, I don’t know. But anyway it is rarer here in America, I think mostly because of the way we intervene and a lot of times the water is broken either intentionally or unintentionally maybe during the cervical exam, but it is definitely amazing.

So she does see in that video that the baby is moving around as if still in the womb and has no idea that he’s just been born. So, yeah, that was incredible to watch.

SUNNY GAULT: I know. Absolutely amazing! Graeme, can you hear me? What did you think of the video? Go ahead.

GRAEME SEABROOK: So, no, I didn’t get to watch the video because I saw pictures and it was a little too much for me. I had a traumatic birth with my first son and I had a c-section and I’m a little birth videos and birth pictures sometimes, a little too much for me. And this one was too. But I have heard that it is amazing and beautiful to watch and I wish that I could see stuff like that, but that’s just one of my personal things that I’m a little fragile about moving forward.

SUNNY GAULT: Yeah. Definitely unique situation, I think anyone that sees this, it’s one of those, it is a water cooler moment everybody. Again, we’ll post it to our Facebook page, so you could check it out if you haven’t already checked it out and let us know what you think.

[Theme Music]

KRISTEN STRATTON: Today on Newbies we’re continuing our series on postpartum mental health. And we’re discussing two very important concerns. Postpartum OCD and Postpartum Psychosis. Our expert today is Doctor Alison Reminick, a psychiatrist with the women’s mental health program at the University of California San Diego Health System. Thank you so much for joining us, Doctor Reminick, and welcome to the show.

DR. ALISON REMINICK: Thanks for having me.

KRISTEN STRATTON: Can you please describe the symptoms associated with postpartum obsessive compulsive disorder?

DR. ALISON REMINICK: Thank you again for addressing these important topics. Postpartum Obsessive Compulsive Disorder often involves really scary upsetting disturbing thoughts. We often describe these thoughts as ego-dystonic intrusive thoughts. An ego dystonic means these thoughts are in conflict or were with a person’s own values and beliefs and a main symptom I would say of OCD is the fear of their own thoughts.

Postpartum OCD is different because these thoughts often revolve around fear of injury or harm to their newborn. A lot of these thoughts or images can be violent or sexualized. Common thoughts I think include “what if I drop my child, what if I stab my child with a knife, what if I suffocate or throw my child out of the window, what if I molest my child?”

The other really common themes are “what if my baby becomes ill and dies? What if my baby stops breathing? What if an intruder comes in and takes my baby?” And I would say when these thoughts occur that women often do everything they possibly can to either ignore or suppress them, by doing something in order to prevent them from coming.

I would say for example my patients who had violent thoughts and images would often dispose of all knives in their house; they may just avoid walking down staircases or even being near a high window. They may not want to be even alone with their child especially with the clients that I have that have fears of molestation. They might start avoiding changing the baby’s diaper or bathing the baby and I would also say that I have clients that have fears of contamination that would also start cleaning obsessively for hours, washing their hands.

The client with fears that baby’s not breathing may just be checking over and over again, going into the nursery, looking at the monitors, making sure the baby is breathing, making sure an intruder didn’t take the baby. So we can see that this wouldn’t mean that they’re not sleeping and often this causes even more anxiety, a lot of sleepless nights, a lot of depression, a lot of panic attacks and a lot of interference with taking care of their child.

I think these women are often really tormented by these thoughts, but also really ashamed for having them, which is why they typically don’t seek treatment in a timely fashion.

KRISTEN STRATTON: And how soon after delivery might a woman begin to exhibit symptoms?

DR. ALISON REMINICK: The question, it’s a difficult question, an answer with certainty because I think a lot of studies has been limited by the times at which point the women seek treatment in the course of their illness, so I think that many women suffer silently for a very long time and their illness will often go undiagnosed and untreated and as I mentioned earlier I think women will wait weeks, even months before they seek treatment, often because they feel ashamed just for having these thoughts.

So I do think that patients who present a postpartum OCD admit to having symptoms even during pregnancy that we just did not recognize. I would say the majority of patients that will have some symptoms within the first six weeks of delivery, but again I think this makes it vitally important to be able to identify and diagnose women early in the course of their illness.

KRISTEN STRATTON: And you mentioned some of the symptoms. But what’s the range of severity of the symptoms?

DR. ALISON REMINICK: The range I think, it can vary in severity tremendously depending on at what point the woman is seeking treatment. Again I think that if we catch the symptoms early the illness can be really mild and easily treated, but again, unfortunately, I would say by the time patients seek treatment they are usually severely impaired by their symptoms and it’s affected their ability to care for not just themselves but also for their child, they’re unable to sleep, so that affects their cognition and I think that in some only perpetuates and intensifies anxieties.

I had patients become really severely depressed and we know that depression OCD are often, they co-occur, I kind of consider them like a married couple, they come together. So these distressing thoughts will often lead to very negative thoughts about themselves, they will often think “what type of mother am I to have these thoughts”.

So at times, women feel the only way to escape their thoughts, it’s to end their life and I think when patients really begin thinking of suicide that’s when they often require hospitalization. So it can be very severe.

KRISTEN STRATTON: Are women with a history of anxiety disorders at greater risk for developing this?

DR. ALISON REMINICK: I would say that a woman who has a diagnosis of any type of mood or anxiety disorder like OCD or general anxieties, will definitely have significantly a greater risk of occurrence during the postpartum period. I would say more than half of those women will have a recurrence of symptoms. However I think it’s also important to know that most women might have never had any history of anxiety symptoms and the postpartum period is when they first start experiencing these symptoms.

KRISTEN STRATTON: And to our panelists, were any of you diagnosed with postpartum OCD and what was your experience?

GRAEME SEABROOK: I wasn’t diagnosed with OCD myself and I only ever had one intrusive thought, which was terrifying and made me very very very grateful that I did not have to go through that. But I have worked with a lot of women who have dealt with OCD or are dealing with postpartum OCD in the support groups that I run both in person and online.

I’ve only ever helped two moms that had postpartum psychosis because psychosis is just pretty rare. I’m sure Alison already said that, but it’s just pretty rare. But there’s a lot of OCD that I’m seeing with moms that I’m working with right now.

LEAH GROVER: Well, I imagine just like all of these mood disorders it’s just really difficult to be caring for your baby and just the daily demands that go with being a mom, and then on top of that to be suffering with these thoughts and feelings and just the lack of time that we allow for ourselves to do self-care, it just exaggerates the promise.

Especially when we have multiple children, I think it’s just really hard to sit there and say okay, I’m having this problem but how am I going to have time to go to the doctor, or go to a support group or you know, we feel like we’re a failure for just having these thoughts and feelings when in reality it’s not that we did anything wrong but it’s so hard in the super mom culture that we have to sit there and say it’s okay for me to be going through something and it’s okay for me to seek help for it. Even if it’s going to make us a better parent, in the long run, it’s just so hard to take that first step sometimes because we feel like we’re taking from our children because we’re not being present 100%, physically a whole all day, day and day out.

But I think it’s important for us to realize “hey, if we’re physically present, we’re not always mentally and emotionally present and we’re important too, moms are important, too.

DR. ALISON REMINICK: I always say that the most important, because it’s so important that they stay healthy and happy to make sure that they are able to take care of their children.

LEAH GLOVER: Exactly. Yeah. I mean we’re the primary caretakers in a lot of households, so if we’re not feeling well, then we can’t be fully present and giving the kids the quality that maybe we want to give them.

GRAEME SEABROOK: Also the great thing about having online support groups, and not just support groups that you know, you have to take time out of your day to go to. There are a lot of support groups that have their own platforms, and then there are support groups that function through Facebook, and Twitter. It’s a great way for moms to reach out and connect with other moms, while you’re cooking dinner, while you’re feeding the baby, while you’re doing everything else that you have to do in your life.

So you don’t have to think “oh, I have to take all of this time out”. It just helps to be able to connect with women while you’re doing everything else that you have to do in your life.

KRISTEN STRATTON: Doctor Reminick, what are some of the ways a woman can seek support and treatment for this disorder?

DR. ALISON REMINICK: Here in San Diego we have the Postpartum Health Alliance, which is a subchapter of the Postpartum Support International. I think usually the best way is to jump on to that website, their Postpartum Health Alliance website, and there are a lot of support groups, therapists, psychiatrists if needed. I think it’s a great resource for any mom who’s experiencing any sort of anxiety or depression.

KRISTEN STRATTON: When we come back, we will continue our discussion about postpartum mental health and learn about postpartum psychosis. We will be right back.

[Theme Music]

KRISTEN STRATTON: Welcome back to the show. We’re talking with Doctor Alison Reminick about postpartum mental health and postpartum psychosis. Doctor Reminick, can you please describe what are some of the symptoms of postpartum psychosis?

DR. ALISON REMINICK: Postpartum psychosis is a medical emergency and I think one of the defining symptoms is really having just a break from reality. So oftentimes people will have delusions, that means they’re kind of like fixed false beliefs, sometimes people just feel like they have grandiose thoughts, like they have special powers, they often have command auditory hallucinations and sometimes being commanded and that means kind of the voices tell them things to do, like hurt yourself or hurt your baby and they feel like this is their reality.

So it’s very difficult because they don’t realize that something is wrong with their brain and they often feel like their thoughts are being completely controlled. Paranoia is also I think a really big symptom that we see in postpartum psychosis so that just adds another layer of difficulty with treating, because they often don’t trust even their family, they think healthcare providers or friends or the government are out to get them, sometimes they feel like they’re being watched and sometimes people kind of have that paranoia around their child, that somebody is maybe out to harm their child. So they can then be very kind of retreat within themselves and not seek treatments.

KRISTEN STRATTON: Is this a mood disorder which can begin immediately or is this the result of another postpartum disorder left untreated?

DR. ALISON REMINICK: I think it can be both because well usually I would say that a psychosis postpartum might be like the first time a woman has ever had symptoms and we really kind of then diagnose this patient with a bipolar illness. That being said too, I had patients who had a history of bipolar illness, they’re at very high risk of developing postpartum psychosis after delivery.

Usually, it occurs kind of immediately within the first two weeks after delivery, sometimes people can be very subtle about their symptoms and keep to themselves, but typically it comes on quite abruptly. Like I said to a lot of moms this is the first time they’ve ever had any mental health issues.

KRISTEN STRATTON: Have there been any criminal cases which women have exhibited violent behavior because of untreated postpartum psychosis?

DR. ALISON REMINICK: I think that this is really the scariest part about postpartum psychosis and why we consider it a medical emergency is because even though homicidal behavior infanticide is rare this is the disorder that would be most concerning for women to do something like killing her child. I often teach about the Andrea Yates’ case. I don’t know if any of you remember that case, but…

KRISTEN STRATTON: Yeah. I remember when that happened.

SUNNY GAULT: Yeah. Me too.

DR. ALISON REMINICK: And it was really difficult because she had a history of psychosis and she was being well treated for it but had many episodes of postpartum psychosis in her three other pregnancies, was told never to get pregnant again, but she did and then went off her antipsychotics and I remember she felt like she was the devil, that she was bad and evil and that killing her children was the only way to save them.

So it’s that type of delusion I think that can really lead someone to commit infanticide, it’s usually in that way that they feel like killing their child would be saving them within their own reality.

KRISTEN STRATTON: Have any women become suicidal or practised self-harming behaviours as a result of their mood disorders?

DR. ALISON REMINICK: I think this is also a big risk as well because I think, I mentioned before, a lot of these patients could have command auditory hallucinations. So those voices that tell them that they’re no good that they need to hurt themselves and it’s really difficult when they start listening to these voices.

So I think it’s again a really big risk for someone not only to potentially hurt their children like Andrea Yates did by drowning of her five kids in the bathtub but hurting themselves during this time as well because they’re being tormented by these voices and their delusions.

KRISTEN STRATTON: And to our panelists. Have any of you experienced postpartum psychosis and would you mind sharing your experience?

LEAH GROVER: I was never diagnosed with postpartum psychosis, so I can only sort of judge based on my own experiences and what I know now about postpartum psychosis. What I know is that I definitely had severe postpartum anxiety and that it manifested in ways that were sort of obsessive and compulsive and occasionally psychotic.

I had, in addition, a condition called dysphoric milk ejection reflex which was incredibly traumatic and complicated where, so a hormonal response to a milk let down instead of being positive hormones basically induce panic attacks. So I would have a full-blown panic attack every single time my baby needed to eat which meant every two or three hours around the clock for months. It was a nightmare.

SUNNY GAULT: Oh, my goodness.

LEAH GROVER: There are still a lot of questions as to whether the dysphoric milk ejection reflex sort of contributes to postpartum psychosis or postpartum mood disorders or whether having a postpartum mood disorder can contribute to developing a dysphoric milk ejection reflex, or D-MER, there’s just not that much known about it.

But I definitely had symptoms of both, so it was a complicated process getting the help that I needed and I always felt for those women that you hear about in the news. There is the one the year before my experience with D-MER and postpartum mood disorders started, who had strapped her child to her chest and jumped off the roof of her apartment building and I just felt for her in so many ways because it was so tragic and at the same time I had these intrusive thoughts that bordered on potentially hearing voices that definitely made me relate to that. It was frightening.

KRISTEN STRATTON: Doctor Reminick, what are some of the resources and treatments available for women who may be experiencing postpartum psychosis?

DR. ALISON REMINICK: I would say again the Postpartum Health Alliance is the best way to go for moms who are experiencing symptoms, but I would say that these patients would need a psychiatrist. So I know there are a few providers in San Diego that can treat these moms but usually, they will need to go to medication and potentially hospitalization, depending on if they are a danger to themselves or to others.

KRISTEN STRATTON: So would you say sometimes if someone is having some immediate violent behavior or they’re talking about harming themselves or harming their babies, that they should go to an emergency room or do we have mental health crisis centers that are available?

DR. ALISON REMINICK: In that sense, I would say absolutely go to the emergency room at that point if someone is expressing the thoughts of hurting themselves or exhibiting behaviors of violence towards another. But I don’t think there are not many urgent clinical psychiatric clinics that I know of.

KRISTEN STRATTON: So, do people if they have that situation do they usually go to the emergency room and then kind of wait for a bed to be available at?

DR. ALISON REMINICK: In-patient unit usually, yeah.

KRISTEN STRATTON: Yeah. Okay. Thank you so much, Doctor Reminick and our wonderful panelists for joining us today in our discussion about Postpartum OCD and Postpartum Psychosis. If you feel like you identified with some of the symptoms we discussed today, please visit the episode page at www.newmommymedia.com where you can find links to resources to get help.

For our Newbies club members, our conversation will continue after the end of the show, as Doctor Reminick will show how family members can help identify and support a woman experiencing symptoms of postpartum OCD or psychosis. For more information about the newbies club, please visit our website at www.newmommymedia.com.

[Theme Music]

SUNNY GAULT: Alright before we wrap up our show today, we do want to share with you some fun way to wrap up the show because it has been a very intense show. We have been talking about some really important topics but it is a very deep conversation.

So I wanted to end things on a bit lighter note, so the baby “Oops Segment” is really fun because it is where you submit funny stories that have happened to you and your babies.  So this one I think we can all relate to on some level so Carey wrote to us; “This is awful with my first child, they didn't give you baby wipes to clean them with. In my little cart, I had diapers, cotton balls, and alcohol wipes. Well, I figured the alcohol wipes were to wipe her bottom with. I was clueless, needless to say, she got a very irritate little bottom. Looking back I almost imagine how much that must have burned.  I have since learned that the cotton balls were too wet to wipe her and the alcohol was to clean her cord. Her little booty is fine now though. I think that is the first time I told that story because I felt like such a bad mom. Lucky my son didn't have to live through that torture.”

When you are a first-time mom you really don't know what is going on. But even I wouldn't even say even the baby wipes, one of my twins constantly gets diaper rash, just constantly and when I need to clean it up and help her out, I even feel back using regular wipes. There is something in the regular wipes that really burns her.

GRAEME SEABROOK: Well the regular wipes have alcohol in them.

SUNNY GAULT:  Exactly they have alcohol in them so even if Carey was using the regular wipes you know might have the same problem. So maybe just grab some water and kind of wipe it down a little bit. That is what I have learned at least; even the regular wipes there are some issues with.

DR. ALISON REMINICK: I like those water wipes.

SUNNY GAULT: The water wipes. Alright, Carey thank you for sending this in and if you are listening and you have a funny story that you are willing to share with us so that we can have a nice little laugh about it. Please send it to us we would love to hear it. you can go to our website at www.newmommymedia.com and some it through the contact link. Or also through the website you can send us a voicemail, just click on that grey little banner on the side that says “send voicemail”.  You can send it straight through your computer.

KRISTEN STRATTON: That wraps up our show for today. We appreciate you listening to Newbies.
Don’t forget to check out our sister show:
• Preggie Pals for expecting parents
• Parent Savers for moms and dads with infants and toddlers
• The Boob Group for moms who breastfeed and
• Twin Talks for parents with multiples.

Thanks for listening to Newbies. Your go-to source for new moms and new babies.

[Disclaimer]
This has been a New Mommy Media production. The information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. While such information and materials are believed to be accurate, it is not intended to replace or substitute for professional, medical advice or care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified healthcare provider.

SUNNY GAULT: How would you like to have your own show on the New Mommy Media Network? We are expanding our line-up and looking for great content. If you are a business, or organization interested in learning more about our co-branded podcast, visit our website at www.NewMommyMedia.com.

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