Sarah Vaughan: ‘I feared I'd push my baby into the path of traffic'

Times

6 days ago

T he stairs of my Edwardian rented house are steep and the drop is sheer. The tiles at the bottom, hard and unforgiving. My ten-month-old son squirms in my arms and, as I sway at the top of them, I see myself dropping him, his tender head smashing on alternate steps as he bounces down.
I'm sleep deprived, in chronic pain, and at that moment the descent seems impossible: even holding the banister, I can't force myself to take a step and, as I hesitate, the incline sharpens. But my inquisitive three-year-old is in the kitchen where there's a kettle and knives. Gingerly, I sit on my bottom, and with my baby clutched to me with my right hand, put my left on the banister, then twist so that he's safe against the stairwell while I manoeuvre backwards. As I've taught my eldest to come down the stairs safely, so I inch my way down, shaking as I do so — 10 steps, 11, 12, 13, 14 …
Fast forward 16 years and I'm on a film set in Budapest, walking up a set of stairs down which the ethereally beautiful Diane Kruger (Inglourious Basterds, Troy) will imagine dropping a two-week-old baby. The exterior of this house overlooks Richmond Green, and all the other house interiors are in leafy parts of southwest London, but due to the demands of production, including the fact that the stairs are surrounded by scaffolding from which bright lights can be directed, the stairs, the bedrooms and the kitchen are being filmed here.
Kruger, with whom I've just been chatting in her trailer, has already filmed a scene in which these stairs appear to tip and sway, and a second in which she unpeels her socks for fear of slipping, then, with the baby clutched to her chest, shuffles down on her bottom. That scene will open episode five of Little Disasters, a six-part TV series that dropped on Paramount+ last week. When I watch the edits, back in my study, months later, I begin to cry.
It's perhaps not surprising, given that the show is based on my 2020 psychological thriller of the same name about the darkest reaches of motherhood. Kruger plays Jess, the seemingly perfect mother among a quartet of women who meet at an antenatal class and, despite having little in common but their due dates, remain friends for ten years.
But perfection is an illusion, as every parent knows and every psychological thriller reveals, and here it rapidly starts to crumble when Jess turns up at A&E with a baby with a bang to the back of her head and a story that doesn't add up. When police and social services are called in, Jess's evasiveness intensifies along with her shame. Through Liz (Jo Joyner, The Wives, Shakespeare & Hathaway), the harried paediatrician and Jess's one-time friend, we come to understand that Jess's perfectionism and overprotectiveness mask an anxiety disorder triggered by the traumatic birth of her third baby, Betsey: perinatal obsessive compulsive disorder (or OCD). In what felt to me like an original set-up for a psychological thriller, Jess is so confounded by her vivid intrusive thoughts of deliberately harming Betsey, she effectively gaslights herself.
When I started writing Little Disasters in 2017, perinatal (then maternal) OCD wasn't something I'd ever read about. Yet I knew it existed. Though I was never diagnosed, I experienced it mildly after having my second baby, when a perfect storm of circumstances — a difficult pregnancy in which I was unable to walk, chronic pain, giving up the job that had validated me, a move 50 miles away at 30 weeks pregnant, and my subsequent social isolation — meant I experienced intrusive thoughts about my baby son and tiny daughter being harmed.
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My disproportionate sense of risk had been heightened by my previous job as a news reporter on The Guardian, where I'd covered the abduction and murder of Sarah Payne, and subsequent trial of Roy Whiting, and the Soham murders. I knew all about little girls being snatched from country lanes as they raced out of sight — something my three-year-old loved to do on her scooter — because that had happened to five-year-old Sarah; I knew little girls disappeared in sleepy Cambridgeshire towns, because for 11 days I'd been based in Soham covering the disappearance of Holly Wells and Jessica Chapman; and I knew children disappeared from bedrooms while abroad on holiday, something that might happen if we left a window open, because, when my daughter was two and I was four months pregnant with her brother, Madeleine McCann vanished.
The cast of Little Disasters
OUGHCUT/PARAMOUNT GLOBAL. PHOTOGRAPHER: MATT TOWERS
As with OCD in the wider population, perinatal OCD is characterised by recurrent unwelcome thoughts, images and ideas — but here they usually revolve around fear of harm to the baby. Dropping the baby is such a typical intrusive thought that a key psychiatric textbook takes this as its title, but Jess sees herself pushing Betsey's buggy into traffic, or smothering her, or a kettle boiling over, or knives spinning from a knife block and falling on her, or chemicals contaminating a bottle of breastmilk that she's pumped. Fear of germs is common and, as with regular OCD, rituals or compulsive behaviours become a means of managing these perceived dangers. As well as her idiosyncratic approach to going downstairs, Jess hides away the knives, toasters and kettle, spins the rings on her finger, and cleans rigorously — the last initially misinterpreted as a perfectionist desire for an immaculate home.
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Such thoughts and behaviours can cause considerable distress, even though the mother may feel 'split' and understand this isn't happening in reality. 'These are very intrusive, ego-dystonic thoughts,' explains the consultant perinatal psychiatrist Dr Maddalena Miele, who points out that these are very different from the fleeting worries new parents habitually experience. 'They can be very graphic and very intense, and although you rationally know you're not doing this [unlike with psychosis, where women believe the thoughts are true] it is very anxiety provoking.'
Thankfully we're becoming more aware of the condition. When I researched my thriller, only 1-2 per cent of mothers were understood to experience perinatal OCD (the same prevalence as OCD in the general population), compared with 10 per cent of mothers with postnatal depression. But better-trained health professionals and a wider understanding of maternal mental health has led to far greater recognition. We now know that perinatal OCD affects 2-9 per cent of women antenatally and 2-16 per cent postnatally, according to a raft of recent studies (the different figures are due to the different criteria applied, from clinical criteria to self-reporting).
So what prompts it? There is no single cause, but a culmination of risk factors, says Miele, an honorary consultant psychiatrist at St Mary's Hospital, London. Being a perfectionist predisposes you, as does having OCD previously or, given that there's a genetic component, having family members who have suffered from OCD.
A precipitating factor would be a sick baby, a complicated pregnancy, or a traumatic birth. A consultant obstetrician once told me that 'birth is the most dangerous day of a baby's life'. One in three first-time births require assisted delivery (ventouse or forceps) in the UK, and 23 per cent of all births here are by emergency caesarean section, and yet expectant mothers aren't necessarily clear about these risks and, in my case, have unrealistic expectations. Jess, who successfully has a home birth with a doula for her first baby, is unprepared for the trauma of her third delivery in which Betsey is stuck and she requires a blood transfusion after a massive post-partum haemorrhage. The sense of an extreme loss of control, and the perceived failure of her body, triggers her perinatal OCD.
And then there are the perpetuating factors, such as social isolation. If you're a perfectionist, used to excelling in your career or at home, admitting to struggling when confronted with something that's supposed to be as natural as motherhood seems impossible. Those suffering tend to be highly skilled at appearing to cope. I knew I wasn't depressed, and I gave every impression of being a competent mother, taking my children to baby groups, cooking everything from scratch and striving to be a domestic goddess. I clearly didn't resemble Diane Kruger, whose character experiences perinatal OCD to a far more extreme degree than me, but I washed my hair and wore mascara every day. I was hardly going to tell a health visitor that I'd stood at the side of the road with my buggy, terrified to cross for fear of pushing it into an oncoming car.
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If perfectionism predisposes mothers to perinatal OCD, then it also exacerbates the problem. 'The baby's not an iPad,' says Miele, who practises at the Portland Hospital. 'You have to let things go and accept imperfections; accept uncertainty. Very driven high-achievers want to fix things; to use the rational, cognitive part of the brain, but you need to allow the limbic system to take over. We come to motherhood with preconceived ideas, but we need a more fluid approach.
'People who are perfectionist have overcompensatory mechanisms. When things go wrong, they do more of the same. And although that coping strategy might work in a work environment — and make you desirable as an employee — it's very risky in motherhood. It prevents you taking a rest. Every bit of spare time you'll be using to try to clean the house or being productive. You get run down. Sometimes you need to leave the dirty cups in the sink!'
The good news is that perinatal OCD can be treated. While some mild cases may resolve spontaneously, mild and moderate cases should be treated with evidence-based psychological intervention such as cognitive behavioural therapy (CBT), and practical measures such as delegating childcare. 'If you're running around with three young children and an absent partner, it's not easy to spend the time required to do CBT,' Miele says. In more severe cases, medication is required, ideally in addition to therapy. The most severe can lead to admission to mother and baby units, but this is rare.
In my case, I had four CBT sessions on the NHS after a perceptive GP asked how I was doing. I see my experience as something discrete, that happened postnatally: I have never experienced OCD since. Swimming once a week, sleeping more, beginning to make friends, being honest with my partner, who was obviously aware I was highly anxious, and growing physically stronger all helped, as did writing — this time fiction. As someone used to gaining validation through newspaper bylines, I gained a sense of myself that was distinct from being a mother, again.
A final thing that strongly contributed to my recovery was the knowledge that perinatal OCD is a form of vigilance and that, as Liz stresses in Little Disasters, there has never been an instance of a mother with perinatal OCD harming her baby — a line we were keen to include in the scripts.
'There's an evolutionary basis to these thoughts,' Miele says. 'As a mammal you have to be vigilant. Motherhood comes with a natural motivation of safety mechanisms. Having an overprotective thought means that we love the baby and want to protect it but sometimes that mechanism goes awry because of the illness of OCD.
'These thoughts aren't a measure of parental malevolence. They come from a place of love.'
Little Disasters streams on Paramount + on May 22. The original thriller is published by Simon & Schuster
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