'I stood near the road terrified I'd push my baby into the path of traffic'
After giving birth to her newborn, a mum of two battled with intrusive thoughts that left her "terrified". Now, she's shed light on the true toll perinatal obsessive-compulsive disorder (OCD) can take.
Sarah Vaughan has opened up about the mental health difficulties she endured after welcoming her second child, which saw her head swirling with unwelcome thoughts, images and ideas.
Thoughts of harming her children, dropping them, or even pushing her buggy into oncoming traffic were just some of the battles she faced. And she's far from the only mother who has had to contend with this.
Author and journalist Sarah poured her experiences of living with perinatal OCD into her thought-provoking novel Little Disasters. The book has now also been made into a six-part series.
The protagonist, Jessica, played by Diane Kruger, is based loosely on Sarah's personal experiences. While not as severe as her book character's story, Sarah's struggle was still a serious one.
"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," she told Sunday Times.
Perinatal OCD is characterised by these thoughts, but they usually stop due to fear of harming the baby. Dropping a baby is a 'typical' intrusive thought people can have. Having a fear of germs is also a common OCD form, as well as rituals and compulsive behaviours.
Sarah continued: "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."
She recalled how these thoughts and behaviours can cause "considerable distress" even though mothers may feel "split" and know deep down it isn't a reality. Consultant perinatal psychiatrist Dr Maddalena Miele pointed out that these are very "intrusive, ego-dystonic thoughts".
Dr Miele said: "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," and said they are very different from "feeling worries" new parents may have.
Perinatal OCD affects two to nine per cent of women, and there is no single reason it can happen. Dr Miele said there could be a "culmination of risk factors" that could lead to it, and the psychiatrist at St Mary's Hospital said being a perfectionist "predisposes you" as does having OCD previously, or having family members who have suffered from OCD.
Other factors could be having a sick baby, a complicated pregnancy, or a traumatic birth. While social isolation could also play a part in the intense feelings. However, it can be treated; some cases may resolve themselves, while some may need psychological intervention such as cognitive behavioural therapy (CBT), and practical measures such as delegating childcare.
In Sarah's case, she had four CBT sessions, and also found that exercising, sleeping better and being honest with her partner all helped her mindset change, as well as putting her feelings into her fictional writing.
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