Author: drchrissyjayarajah

The Woven Child – reflections on the Louise Bourgeois art exhibition

The Woven Child – reflections on the Louise Bourgeois art exhibition

by drchrissyjayarajah ♥ 0 Leave a Comment

Opening Disclaimer: Please note as was expressed in booking at the gallery, it is important to mention that should you wish to visit, the following exhibition includes artistic depictions of a sexual nature, nudity, pregnancy and childbirth – which may or may not be triggering to those attending or reading this article.

It was my absolute pleasure to spend a Spring afternoon at the Hayward Gallery in London, exploring this vast yet intimate collection of key pieces of art by the artist Louise Bourgeois.

I must confess that I knew very little about the artist prior to the exhibition, however am grateful to have a friendship circle whom are self professed textile enthusiasts, and suggested we go together, which in itself was lovely as one of my first ventures back into the “real world” not only post lockdown but also sans children, signalling the transitional end to my maternity leave and return to *clinical work (*I make that distinction as anyone whom has children knows, looking after children is an very much hard work in itself which should be treated with respect and recognition).

The collection itself is the largest curated body of her textile based art work, which I was surprised to find out that she only pieced together in the last two decades of her life, from the age of 80 until her death in 2010, at 98 years young. Of the many reflections I have of the exhibition, this is probably the most poignant, as it got me thinking about how many of us rush through life like there is a deadline to complete, or achieve milestones by a certain age or imaginary date – pressured about the uncertainty of our final hour – when in actual fact there is no age limit on our ability to evolve, create or start a new chapter.

Despite my morbid introduction, the exhibition itself focussed very much on the aspects of birth and mothering, both the child and the woman herself as she is “birthed” into the role of motherhood . Louise was able to articulate and express herself through beautifully intricate yet simple sculptures, paintings, and textiles. She experimented with various fabrics and objects, often jarring with one another (delicate silk lingerie, next to jagged wood for example) the manipulation of a number of techniques to include weaving, embroidery, sculpture, quilting, printing and painting, to name a few.

One of her most famous art installations is that of the Maman, a large sprawling metallic spider sculpture made of steel, which gave her the apt nickname “spiderwoman”. I have memories of this being installed at the Tate Modern in London over twenty years ago now, though at the time in the follies of my youth I never thought to think of its significance. Louise describes the Maman as “an ode to (my) mother” – and likened the spider to mothers in how they weave a web of family life and memories together, and are also helpful and protective creatures as they eat mosquitoes, an insect carrying toxins and that would bring harm to others. This is not unlike the many mothers I meet in clinic and on maternity ward, whom, within a few seconds of giving birth, note a complete overhaul of their priorities, roles and responsibilities, and where the “mama-bear” protectiveness becomes paramount. The Matriarch is born in front of our very own eyes, and even when a child grows up, leaves home and has a family of their own, these somewhat primal instincts and neurochemical tinglings of love and affection never truly fade, as being a mother takes centre stage in her core identity of being.

I was moved by a number of the works, but mostly the namesake of the exhibition which was on the ground floor. I was particularly struck by the doll like woven padded female figurines placed in various positions not uncommon in the mothering journey, including the pregnant body, image of the foetus (incased in a pink mesh), lying in the foetal position on the bed and another on her back with baby born still attached by the umbilical cord. The art works were sexual and graphic in nature, and at times shocking and uncomfortable, but still retained an element of femininity and wonder – much like pregnancy and childbirth itself.

Its hard to pick a favourite piece of work, but if I had to choose I would say it was the sculpture of the “Good Mother”, pictured above. It is of a female figure, on her knees, her breasts attached to 5 spools of thread around her. The art evoked in me a strong a sense of sacrifice and selflessness, to have the spools attached, or should I say, literally hanging by a thread off her nipples whilst she has a tired and forlorn expression. I am yet to meet a mother whom has not had that experience, often smiling through the exhaustion, of trying to being more than “good enough” (which although Winnicott writes about poetically, is often easier said than done). I also began to wonder what these spools represent in our busy modern lives – Louise Bourgeois created a lot of art with themes centred around not only motherhood and parenting, but also on domesticity, childhood trauma, hidden emotions, mental health, sexuality and the patriarchy. In actuality, there are many things, places or people, both past and present, in our fantasy and our reality, that we may be holding onto, even by just a thread. Those of you whom have worked with embroidery thread will know that it may appear dainty and fine but it is extremely strong and not something you can easily break – so the act of being pulled in different directions, coupled with our efforts to continue to live up to the exceptions (of ourselves as much as of others), is enough to weigh anyone down.

The Woven Child is on display until the end of the week, 15th May 2022, so if you are in the area and/or passing through Southbank in London and have an interest in motherhood, sexuality, perinatal mental health or just want to see some great textile art – please do consider going along.

Final Disclaimer: It goes without saying, but I suppose I must declare in the world we live in now that this was not a paid or sponsored post – I am not an “influencer” in any fashion, but rather just someone that enjoys art and wanted to share her reflections as a Perinatal Psychiatrist, Mother and Quilter (not necessarily in that order).

Mummy can’t breathe

Mummy can’t breathe

by drchrissyjayarajah ♥ 0 Leave a Comment

Hi all – it’s been a long time – I wrote this over a year ago, and it has been sitting in my drafts gathering virtual dust. At the time it was incomprehensible that the coronavirus would continue to cause chaos in our lives. I’m sharing this because the story might resonate with someone, but also because I think it is time and a story that needs to be told.

On my first mothers day I woke up in the morning unable to breathe. After almost of week of feeling poorly with a cough and on/off high temperatures (? spiked by watching the news) I was sitting with my 9 month old baby singing nursery rhymes, and I couldn’t get past the “Old” of Old McDonald had a farm without gasping for air. You don’t need to be a medic to know that this state of breathlessness is not normal, so, reluctantly, I called 999. As I gave my name and address, I profusely apologised for “wasting their time” and, whilst struggling to speak still managed to say

“I’m (gasp) sure (gasp) its (gasp) nothing”.

A couple of hours later I was being blue lighted through the empty inner London streets in the back of an ambulance with a Respiratory Rate of 44, Temperature of 39.6 degrees Celsius, and an oxygen saturation around 85% – worse than a lifelong chain smoker (for the record, something I am not). When the ambulance crew arrived it was plain to see I was seriously ill – yet even with all my years of training and expertise I refused to go to hospital, because I refused to leave my baby. She needs me, I kept saying. We had not been even an hour apart since the moment she was born. Shes breastfeeding. “I can’t leave her” I gasped, over and over again. To this day I’m very thankful to the paramedic, whose name I cannot remember whom casually said “hey I tell you what – just come with us, let us check you out in A&E, make sure everything is OK and you will be back home in a few hours”. Obviously that was a lie, but one of those little white lies that saves lives that sometimes we have to do.

The next 4 days was a blur. I was placed in “isolation” – alone in a large magnolia coloured room with a small window that faced a red wall. Nurses came to check on me regularly, albeit from a distance covered head to toe in personal protective equipment. I was placed on oxygen therapy and given antibiotics. I was in such a septic rush that I didn’t pack anything in my hospital bag but some old pyjamas, a gym t-shirt (?), a small bottle of holy water from my mother that I’ve always carried with me whenever I travel, and a portable phone charger which was only 10% charged itself. I used my phone sporadically, only to face-time my daughter for a few seconds at a time before her naps. I didn’t pack a breast pump, the thought hadn’t even crossed my mind – until a few hours later when I was struggling with engorgement and doing my best to hand express into a kidney dish through the night to stop myself getting mastitis on top of everything else.

A few days later with improved oxygen saturations I was allowed to leave hospital as I was mostly better (on retrospect not fully recovered by any means – but I think they gave me the benefit of the doubt being a “sensible” doctor, whatever that means…)  I was told a few times that I should stop breastfeeding and be separated from my baby for a number of reasons – “coronavirus could be in the breast milk”, “you could harm your baby”, “you could infect her” , “the antibiotics might not safe” , and possibly the most patronising “well you have had a good run”, all of these claims totally false and founded in fear rather than facts, and although I knew it was false with my clinical expertise I was too weak to argue with them at the time so chose to save my (much needed) breath.

As soon as I came home, I gave my daughter a huge hug and she went straight back on the breast like nothing had ever happened. Since then so much evidence has come out about the benefits of breastfeeding and its immuno-protective qualities – something that needs to be shared more and one of the reasons I have chosen to share my own dual patient and professional experience. I have also written to our government and with organisations behind the scenes to support the often neglected needs of breastfeeding women admitted to hospital and separated from their children, both on a practical and emotional level.

It took some time to recover, but I am thankful to say that from a physical perspective I am back to normal and honestly it is a wonderful feeling to not only be alive, but to be able to breathe, talk and sing with ease again. Being unable to breathe is so anxiety-provoking, not surprising as the breathing control centre, stress and anxiety are intricately linked by the vagus nerve. Deprivation of the breath of life also conjures images of death – since writing this original article, the world witnessed the tragic murder of George Floyd in 2020, repeatedly stating “I can’t breathe” to his oppressors, igniting the black lives matter movement for the next generation.

Psychologically speaking, I also feel very well and grounded – but even the process of writing this has raised a lot of questions for me; how mothers/daughters/women in caring roles default to “putting others needs before their own”, and how the line between doctors and patients is truly blurred in times of sickness and health. These questions are something I explore a lot with my patients, so pertinent in the perinatal period, but maybe we can talk about that another time.

I’m thankful to my husband whom looked after our infant alone in lockdown without any support from family or friends during that first (of many) lockdowns. 

I’m thankful to the lady on the end of that breathless 999 call who told me to take care of myself.

I’m thankful to that paramedic that told me a white lie.

I’m even thankful to the junior doctors whom did countless arterial blood gases on me (with and without local anaesthetic).

I had to make a split second decision about coming into hospital, and I’m thankful I made the right one.

.. and even though its taken me over a year to gain the courage to do so – I’m thankful I am able to share my story.

When ladies lose their temper : understanding postnatal rage

When ladies lose their temper : understanding postnatal rage

by drchrissyjayarajah ♥ 1 Comment

Hi everyone,

This topic has been on my mind to talk about for weeks (months at the time of publishing publicly) , and everytime I have tried to sit down at the laptop something else comes up (usually baby sick, actually) and the idea gets shelved in the corridors of my cortex. So here I am at 3am (yes – 3am) writing to you all about a hot topic, RAGE… and warning, it might make you feel a bit, well… angry!

Postnatal depression is by far the most common and well known of all the perinatal mental health conditions, and the symptoms of which are very similar to that of a “standard” non pregnant/postnatal depression – however – one symptom that comes up time and time again that is unique to the experience of postnatal depression for many women is that of increasing anger and irritability. In fact, it can often be the first presentation of postnatal depression, but many will ignore it as just “hormones” or “lack of sleep” or “expected”. Should you experience irritability or mood swings, particularly with the other core features of depression (will not list them all but examples such as loss of enjoyment in things, persistent tearfulness, feelings of guilt and worthlessness, or things are getting worse feeling that it is no longer worth living   then i would certainly recommend seeking immediate help as treatment IS available and DOES work.

In this post, however, I want to take a closer look at unilateral postnatal rage – when anger is the prevailing and only symptom, in the absence of any other mood symptoms. This may be controversial, but I would say that in this instance – rage is not an illness,

The more I have been thinking and reading about rage (as well as examining my own feeings of postnatal rage) I have come to understand that the topic is complex and fascinating in its own right. Women have been conditioned for centuries to hold their temper, to reveal such emotions was considered extremely “un-lady like” and the subtext of this remains strong in our society today. In fact, in the Victorian Era, melancholy was seen to be more “attractive” in a woman, as it evoked a sense of being a victim (thus needing a strong man to save her). You only have to refer to the media frenzy that occured when Serena Williams famously lost her temper in the 2018 US Open Tennis final against Naomi Osaka, which sparked a debate how men are allowed, even celebrated, when showing aggression whereas women are demonised and punished for daring to express themselves. Many asian cultures place greater importance on this, where women are often taught to be passive and subservient in nature.

There is also understandable rage in relation to the despair of not being able to meet the high expectations placed on women to “have it all” – to work in their careers like they dont have children, and to look after children like they do not have to work to pay the bills. Trying to have a decent work life balance can at times feel like shoving a square peg through a round hole and is enough to make anyone full of rage. Again, the stark contrast of fathers returning to work (with their body and life largely “back to normal”) can also be difficult to comprehend. The Feminist and sociological literature surrounding this topic is an actual delight and deserves a blog post all to itself, but in a nutshell within the patriarchal system within society reigns supreme and one must place the experience of rage (or rather, the perception of anothers rage) within this context.

There is also the concept of “vertical transmission” of female rage – whether that be because there is a lineage of strong, defiant women – or – rage “against the machine” so to speak of being at odds with the women that have come before you (something very pertinent to mothers learning to mother in the shadow of their own mothers, with the weighty expectations of the mothers before her) leading to friction within families about differences in parenting styles and practices. Although I am yet to find a paper discussing this, there is plenty on the topic of the vertical transmission of trauma, which, I believe is for many the core of their unexplained expressed rage.

How about the biological argument ? The concept of Maternal aggression has been studied for many years in animals. I recently learned that the agapornis (commonly known as love birds) are widely misunderstood as “needing” to be in pairs, where in fact they are better suited to being alone – the female can become extremely aggressive particularly when hormonal and is at risk of killing the male species (!)As we know in the postnatal period the mother is a flurry of oscillating hormones re-calibrating themselves to their pre-pregnancy state, whilst, at the same time, with the understanding that they never be the same again. Having a baby releases a rush of hormones including oxytocin, vasopressin as well as seretonin and CRH (cortisol releasing hormone) which most recently has been linked to levels of maternal aggression – that protective “mama bear” instinct where a mother would do anything to protect her child from harm. So yes, it could be your hormones playing up – but that is only one piece of the puzzle, and I am always wary of the minimisation of symptoms “just because of a hormonal imbalance”.

So we appreciate that rage can have social, familial and biological roots, but how can this help us in our modern day, rage inducing circumstances ?

R = Reflect on your narrative

How was rage expressed (or not) whilst growing up? Do you come from a family used to having shouting matches across the dinner table, or a home where expressing ones disagreements were frowned upon. How about your partner, your colleague or your parents? how were they brought up? Much of the conflicts we find ourselves in can be found in the spaces between us – the differences of opinion as well as the differences in managing moods. You will soon learn this if you are the type to want open dialogue about every issue and the other is someone that prefers to bury their head in the sand!

A = allow yourself to feel angry

The expression of anger is such a taboo in our society, especially in the virtuous, ever-sacrificing mother. As long as you are not putting yourself, or others in harms way – it is acceptable and even at times advisable to let go of some steam. Sublimation is a mature defense mechanism of transferring an unwelcome socially unacceptable impulse into a positive and accepted behaviour. A good example is taking out that frustration in a kickboxing class! channelling all that energy into something that  will make you feel good but at the same time will expel that nervous energy, which if left inside may implode. If all that sounds too strenuous (especially whilst caring for a teething baby…) there are plenty of other positive ways to channel your emotions – and even just acknowledging them out loud ” I Feel angry because….. (Fill the blank)” can often be enough to address the moment to allow it to pass unscathed.

G = Go to sleep 

Sleep deprivation is real, and is the number one reason why you probably have a shorter fuse than usual. I remember before having a baby, I would naively advise in clinics to “sleep when the baby sleeps” – but now being on the other side I understand that this is not always possible. The “downtime” of naps are often when mothers try to accomplish everything on their never-ending to do list (try being the operative word – many of us just revel in mindless scrolling …)  I would however urge you to put the list (and phone) down. If you are at the end of your tether, the vacuuming can wait one extra day. For me personally I make sure to take at least 2 nights a week where I go to sleep early the same time as the baby. This guarantees me a few solid extra hours (which would probably be sat in front of the TV mindlessly) to recharge, and I am a better parent the next day for it.

E = eat well and exercise

Eating for wellness and exercise sounds boring but is absolutely essential, and trust me I have heard (and personally used) every excuse in the book, but it does not make it any less true. The reason why I’m including this in the management of rage is because part of the reason rage is surfacing is because there is a significant loss of that internal locus of control and power, and if left to linger will result in deep resentment. The rage presents itself as a response to the panic within us when there is a threat. The arrival of a newborn is not a threat per say, but it is a perceived threat to the life you once had – your brain is now in overdrive on constant HIGH ALERT caring 24/7 for a helpless individual that is your responsibility – but what about you? who is looking after you? We as women often lose ourselves in the “Caring” role (whether that be for our own children, our parents or our clients) but are the first to neglect ourselves. To eat well and to exercise, in whatever form that takes, is the acknowledgement to yourself that YOU MATTER. It is a form of selflove a respect, and brings back a sense of routine when feeling overwhelmed.

 

I hope this is helpful for whatever stage of life you find yourself in to take from it what you need.

Much love

-x-

 

An ode to breastfeeding

An ode to breastfeeding

by drchrissyjayarajah ♥ 0 Leave a Comment

Hi everyone

Well, hello from the “otherside” – apologies for the radio (blog?) silence but for good reason – I am officially a mother now to our beautiful baby girl born six weeks ago – she is absolutely precious and what a month it has been. I have so much to say and so much to tell you – but have to grab the few peaceful minutes here and there whilst my newborn naps (as I am sure many of you will understand).

Whilst on maternity leave one of my resolutions is to write more on the blog, I want to continue to embrace the dialogue surrounding maternal health, with the added bonus of sharing my own “lived experience” which will no doubt accent my academic understandings.

The go to first topic to discuss would be around my pregnancy and labour experience – but I will intentionally leave this for another time, as I feel a pressing need to give attention to something very rarely talked about in clinical settings – and that is the topic of breastfeeding. It is something I know quite a lot about from a medical perspective, and was kindly invited to speak at the Great Britain Lactation Consultants conference last year on the use of medication whilst breastfeeding, however only recently have had first hand (breast?) experience of.

There is often so much emphasis placed by staff and patients alike on the birth experience (and yes, I have seen laminated birth plan 5000 word essays) but by doing so its almost like focussing all your energy on planning the wedding without giving a second thought to the aftermath of having a happy and healthy marriage.

The topic of feeding your child is complex – specifically the intention to breastfeed and the emotions evoked when this is not as easy as one hopes/assumed it would be. Nursing your child carries a heavy psychological weight. It is associated with being a bountiful women able to nourish and provide for her baby from her breast, with any deviance from thus idealism deemed as defeat with feelings of failure, guilt and shame… emotions I have often seen women in clinic struggle with, and many have told me the stress  of which triggered their postnatal depression. There is also an additional dichotomy women face of being divided in their position between the maternal and the sexual – with the depiction of breasts throughout modern history as erotic rather than a practicality perpetuates this (often collective societal subconscious) conflict. I remain in awe how a woman can be half naked exposed on a massive billboard on a train platform, marketing, well, anything (don’t you know sex sells, darling) yet a woman trying to breastfeed her child on same platform with a fraction less exposed skin will face all sorts of spoken and unspoken commentary. This manifests itself in those same feelings of guilt and shame, except this time when needing to nurse.with a third of women feeling embarassed to breastfeed in public .

 

Although it is well known that breast feeding has a range of benefits for the child, The UK interestingly has one the lowest rates in the World, with only estimated 1% of mothers exclusively breastfeeding at 6 months postnatal. I would recommend everyone to check out the great baby friendly initiative from UNICEF if this is something of interest to you – as they are championing change in attitudes towards breastfeeding on a societal and political level. The Lancet also published a fantastic comprehensive series on breastfeeding with an interesting economic analysis, with a noted difference through rich and poor, in sickness and in health – with rising popularity (and prices) of substitute milk formula, preferred by many lower socio-economic communities as breastfeeding is becoming to be seen as “primitive”. Since becoming a mother of course I have naturally become interested in the activity that takes up most of my day, but there is so many opinions and conflicting information on the subject – and then theres the pumping and expressing..

 

                    ... dont even get me started on expressing and the world of breast pumps!

 

All of that is fascinating in theory – but what about in practice? I put myself to the test and just had my first experience of trying to breastfeed alone in public – in a busy Starbucks no doubt (insert despair emoji here).

It was all going so well, until the little one started screaming and there was no where to hide. I suddenly felt all eyes on me, and a sense of “why can’t you control your baby  – you are ruining our afternoon coffee”. I then realised this was my moment to fly the #normlisebreastfeeding flag – so i sat down, got my big muslin shawl and tried to console my newborn, but i couldn’t get comfortable as she continued to scream and i got so frazzled trying to not expose myself i ended up getting tangled with my head under my scarf ! when i managed to detach myself I realised my “quiet corner” was in fact in front of a full glass wall, with plenty of onlookers witness to my meltdown. Just before I tipped into full panic mode I decided to try make a gracious exit – but the pram got stuck in the doors as the entrance wasn’t wide enough – i pressed the disability button (for wheelchair access assistance) but the baristas paid no attention to me or my screaming newborn. Eventually a man helped by unlocking the double door and I RAN as fast as my buggy would allow.

Although on the surface it wasn’t the best experience and the young women next to me gave me and my screaming daughter a disapproving stare – I am glowing with pride for leaving the house alone with my newborn for the first time (after an emergency caesarian section) and for managing to overcome my fear to feed her in public.  I still have a lot to learn, but I feel proud I did my tiny part in challenging societal assumptions and normalising the highs and lows of breastfeeding! I am a huge advocate of the movement “fed is best” , rather than the “breast is best” mantra many women have grown up with. Breastfeeding of course has a wealth of benefits, but none of these matter if you are either unable to physically breastfeed or the perfectionist pursuit is causing nothing but stress and anxiety (both of which will rapidly cease your milk supply anyway!)

However a women chooses to feed her child through breastmilk, formula or a combination of both – it is our duty (as health professionals and members of society) to empower them and eachother to create a space (physically and emotionally) that is safe for families to nuture their children. I have learned so much in these short 6 weeks, and will continue to advocate this issue with a passion as I believe it is a womens basic human right. I think we also need to do a better job of preparing women in pregnancy for the reality of life in the immediate newborn period, because it is not all cute baby clothes and cuddles (although there is a lot of that!).

What are your thoughts on breastfeeding ? have you had any experiences of nursing in public? do let me know in the comments below or on twitter

Much love

Cx

 

 

 

Maternal Instinct vs. Maternal OCD

Maternal Instinct vs. Maternal OCD

by drchrissyjayarajah ♥ 0 Leave a Comment

Hi everyone

Apologies for the radio (web) silence for some time. I took a little break from the online realm to focus on the real world – both professionally and personally, but you were never far from my mind I can assure you. I hope you are all well and enjoying 2019 so far.

I wanted to bring our focus and attention to a topic very close to my heart – the condition that is Obsessive Compulsive Disorder (OCD) and particularly OCD that presents in the perinatal period, often described as “Perinatal OCD” or “Maternal OCD”

Some of you may know that I have done some work and research on Maternal OCD – I founded the (hashtag) OCDBFING movement on Twitter and collaborated with charities Maternal OCD and OCD Action in doing a live twitter Q&A a few years ago. I am also work voluntarily as a scientific advisor for the Maternal OCD charity, and my specialism looks at diagnosing and treating OCD in the perinatal period, particularly looking at the effects of medication use in pregnancy and breastfeeding (something I know is a worry for many).

A question I get often about Maternal OCD, and OCD in general, is that isn’t it “normal” to be “a bit OCD anyway” ?

Its something we hear often people speak of in jest – though for me I find it personally as offensive as when people refer to (- minimise – ) individuals suffering with mental illness as “nuts, crackers, mad, or crazy” – words that are neither accurate nor helpful. OCD isn’t just about cleaning or liking a tidy decluttered home that “sparks joy” (don’t we all…)

Obsessive Compulsive Disorder falls under the umbrella of anxiety spectrum disorder; it is cousins with other conditions such as panic attacks, phobias, and health anxiety. It can be quite difficult to diagnose, particularly in the perinatal period – a time in a womans life where she faces the most change she is likely to ever encounter  (biological, emotional and relational). Should a woman present to health services seeking help (often something very difficult to do) it is often confused with post natal anxiety, depression, or even Psychosis in extreme cases. It is characterised by two phases, an “Obsessional phase” – thoughts, fears or beliefs that increase ones anxiety, followed by a “Compulsive phase” routines, rituals, or behaviours with the aim to reduce the feelings of anxiety – even (and commonly) temporarily.

In the perinatal period – we are faced with a different challenge. At the end of the pregnancy,  there is a new beginning – a tiny new life one is now responsible for 24 hours of the day, 7 days a week (and these intesne, almost obsessive feelings of care and responsibility doesn’t magically “disappear” when they leave home later in life).

With the influx of oxytocin (the “falling in love” hormone) as well as other biological changes in the blood and brain, mothers will often develop this “maternal instinct” – this feeling of the need to protect their child at all costs. This is why I tell my mothers in clinic that a “little bit of maternal anxiety is normal and natural” – it would be strange for a mother to not care about their childs safety – whether it be ensuring the hot cup of tea is a safe distance away from the table edge, or making sure the car seat is clicked in securely before a road trip.

So, if this protective “mama bear” instinct is normal and natural, where does OCD – a condition rooted in anxiety (often presenting in clinical practice as fear of harm occurring to the child) fit ?

From our clinical experience, the important factor is to consider how much these worries (natural or otherwise) are affecting your quality of life, your relationship with your child, your family and wider social circle. There is a massive difference in someone whom is worried about their child catching the seasonal cough of cold in the playground, to someone that will avoid interactions with others at all costs – housebound with their child as a result, afraid to send their child to school all term or have anyone (even their partner) hold their child without disinfecting themselves head to toe. It also may start to interfere with the mothers own well being – from the way she thinks about herself, to her mood and her sleep (which is often disturbed by “googling online until the early hours of the morning”…)

Often, with Perinatal OCD – no amount of “cleaning” or “checking” or “avoiding” the fear will make it go away – in fact, it serves the opposite purpose by reinforcing the inner fear, which will grow and require constant thought and attention – thus becoming an “obsessive rumination”.

Maternal OCD can present in a number of ways, from obsessive thoughts about fear of illness, harm or contamination (cue constant disinfecting of babys bottles and laundry on loop) to other examples of constant obsessive worrying (for example unwanted sexual thoughts – particularly problematic in breastfeeding). Uniquely, women may often experience disturbing visual images along with the anxious thoughts, sometimes numerous times a day – something which does not present typically postnatal depression.

Often partners and family members (and even professionals) can get caught in the vicious cycle of reassurance  – they may be asked to check/double and triple check that everything is “safe” – whether it be the doors are locked, the hob is turned off, or constantly stating that they are not a “Terrible mother”.  The important thing to realise is that however horrific the thoughts are – OCD is egodystonic – aka the thoughts are “alien to them” they are aknowledged as conflicting, incorrect, illogical, repulsive and distressing to the mothers sense of self or beliefs system, and there is no actual real harm or intent of harm o the child, ever.

So what happens next? firstly – if any of this is ringing any bells (for you or someone else you might know) please do not hesitate to ask for help. Speak to your GP,  midwife or health visitor and ask for a referral to your local Perinatal Mental Health specialist, because of all the conditions we come across – Perinatal OCD is one of the most treatable conditions once it is correctly diagnosed. Treatment comes in all shapes and sizes, often utilising talking therapy combined with “practical” therapy of putting those fears to the test (in baby steps). In some cases, medication can also be extremely helpful – and it is important to note that the medication needed to treat OCD is often at a higher dosage to that prescribed in postnatal depression and anxiety (thus I have seen many women on medication stuck “half cured”).

If you want to learn more about this condition – including some phenomenal success stories spoken by the mothers whom have been through it all and come out the other side stronger than ever – please check out the Maternal OCD charity website http://www.maternalocd.org

I also did a podcast with Maternal OCD summarising Perinatal OCD and the use of medication specifically in breastfeeding – which is still available online via the website or on youtube here.

[Side note: Podcasts have become my new favourite thing – and actually (spoiler alert) I’m planning on adding a few more here on the blog, so please let me know if this is something you are interested in and if so what you would like me to discuss!]

with love

Dr Chrissy Jayarajah