Anxiety & OCD During Pregnancy, TTC & Postpartum
Divya Robin, LMHC, LPC | Therapist in NYC, Hoboken NJ & Montclair NJ
I started my career as an anxiety and OCD therapist.
When I graduated from Columbia, I started a two-year-long fellowship of deep, advanced work in CBT, ERP, and ACT, learning about the ins and outs of anxiety and OCD alive. I specialized in that work, and did really good work with my clients.
And then something happened that I didn't entirely expect. A theme that kept coming up again and again with my women clients (since I worked with many women between 20-40 years old).
These women started talking about trying to conceive (ttc in the fertility community), getting pregnant, staying pregnant, fertility treatments (IVF, IUI), and reproductive mental health. The anxiety that these women already had in their lives took on another form. This did not come as a surprise to me as an anxiety/ocd therapist - because the anxiety or intrusive thoughts are often centered around what is important to you.
I saw two buckets of clients
1) Existing clients where their ocd/anxity themes shifted toward pregnancy and postpartum.
2) Not existing clients/new clients. They were women who would say in consults, “I was never anxious before,” but that when entering the reproductive chapter of their lives, they were met with anxiety, intrusive thoughts, or hypervigilance.
I kept seeing it. Over and over. And I realized: this is its own thing. It deserves its own attention.
That's how reproductive mental health became a core part of my practice, not as a departure from anxiety and OCD work, but as a natural extension of it. Because the truth is, the perinatal period trying to conceive, pregnancy, and postpartum is one of the most anxiety-activating seasons of a woman's life. And when you already have an anxiety disorder or OCD, it can become one of the hardest.
Why the perinatal period is so anxiety-activating
Let's start here, because I think it matters: there is nothing wrong with you for being anxious during this season. There is a reason this time of life hits so hard, even for women who have never struggled with anxiety before.
The perinatal period asks you to surrender control over something you want more than almost anything else. Over your body. Over the outcome. Over whether everything is okay. And if there is one thing anxiety cannot tolerate, it's uncertainty over something that matters enormously.
Add to that the hormonal shifts which are real, significant, and have direct effects on the nervous system. Add the identity upheaval of becoming a mother, or trying to. Add the medical system, which is full of monitoring and numbers and waiting and information that you then have to sit with. Add a culture that tells you pregnancy should feel like a glowing, grateful experience … and the shame that follows when it doesn't.
What you get is a perfect storm for anxiety. And for women with existing anxiety disorders or OCD, that storm can feel more severe. And many women sit in this storm isolated. Therapy is a place to move through this with resilience, strength, and trained therapeutic support.
Anxiety when you're trying to conceive
For a lot of women, the anxiety starts here. Before there's even a pregnancy to hold.
Trying to conceive has a particular texture to it that I think is underappreciated clinically. It is a months-long, sometimes years-long experience of hoping and waiting and not knowing, cycling through possibility and disappointment on a schedule your body sets and you cannot control.
Your brain … especially an anxious brain, responds to that with hypervigilance. You monitor every symptom. You track everything. You spend the two-week wait in a state of suspended, bracing hope. You learn not to let yourself believe too much, because the crash, if it comes, is brutal.
And with each cycle, each negative test, each month that passes, the anxiety often compounds. The uncertainty becomes harder to tolerate. The control strategies multiply: more tracking, more researching, more asking, more planning, and the relief they provide gets shorter and shorter.
For women with OCD, this can be a significant trigger. The intrusive thoughts that were already present find new content here. The compulsive reassurance-seeking gets louder. The need for certainty in a situation that has none is a particular kind of torture.
I work with women in NYC, Hoboken, and Montclair who are in the middle of this, actively trying, navigating fertility treatment, somewhere in the grief of it not happening as planned, and the work we do is specific to this. To the unique anxiety of wanting something this much and having no control over whether you get it.
Anxiety in pregnancy, including after loss or fertility treatment'
Here is something I wish more people talked about: pregnancy does not automatically make the anxiety go away.
For women who struggled to conceive, who went through fertility treatment, who experienced a previous loss, pregnancy is often not the relief they were waiting for. It is its own anxious chapter. The fear doesn't lift. It changes shape as weeks and trimesters move along.
You spend the first trimester bracing. Then waiting to get through the anatomy scan. You count the weeks until viability. You hold your breath at every appointment. You don't let yourself buy anything or tell anyone because some part of you is still waiting for something to go wrong.
That is not irrational. It is a completely understandable response to everything you've already been through. But it is also a form of anxiety that deserves to be treated, not dismissed, not normalized away, not met with "but everything looks fine."
And then there's prenatal anxiety more broadly, which affects far more women than postpartum depression does, and receives a fraction of the attention. Prenatal anxiety can look like:
Constant worry about the baby's health, even when reassured
Intrusive thoughts about something going wrong during pregnancy or birth
Hypervigilance about every physical sensation
Difficulty sleeping, relaxing, or feeling present in the pregnancy
Excessive worry before scans or doctor’s appointments that hinders with functioning
Compulsive reassurance-seeking (repeated calls to the OB, repeated Googling, repeated checking.
For women with OCD, pregnancy can be a particularly acute trigger. Perinatal OCD is real and it is underdiagnosed. The intrusive thoughts that characterize OCD often become focused on the baby: fears of harming, fears of something being wrong, fears that feel completely at odds with how much this baby is wanted. I always remind clients who come with perinatal OCD … thoughts are not wishes or predictions. They are OCD doing what OCD does. Treatment is possible and can be incredibly effective.
Postpartum anxiety and OCD: the thing we don't talk about enough
We have gotten better, culturally, at talking about postpartum depression. That is good and important. But postpartum anxiety — which is at least as common, and for some women more so — still doesn't get the same airtime.
Postpartum anxiety can look like:
Being unable to sleep even when the baby sleeps, because your brain won't turn off
Constant intrusive thoughts about something happening to the baby
Checking behaviors — repeatedly checking breathing, temperature, position
Fear of being alone with the baby, not because you want to harm them but because your brain keeps generating "what if" thoughts you can't stop
A hypervigilance that feels necessary and is also completely exhausting
A sense that something terrible is about to happen, all the time, even when everything is fine
Postpartum OCD specifically involves intrusive thoughts often about harming your baby that cause intense distress precisely because they are so contrary to how the mother actually feels. These thoughts are terrifying to the women having them. They're also extremely common, frequently go unreported because of shame, and respond very well to ERP and CBT when treated properly.
I want to say this clearly, because I think it matters: having intrusive thoughts about your baby does not make you dangerous. It does not mean you will act on them. It means you have OCD, and you deserve treatment from someone who understands OCD and the postpartum period.
How I work with anxiety and OCD in the perinatal period
What I bring to this work is the combination of my anxiety and OCD training and my deep familiarity with the reproductive context … the emotional weight of it, the medical reality of it, the specific fears that live in each stage of it. Because I too have lived in this space. I understand the nuances personally and know what clinical support looks like.
That means treatment is always specific. We're not doing generic anxiety management. We're looking at:
What stage of the perinatal journey you're in and what that stage specifically activates
Whether OCD is present and if so, what the content of the thoughts is and what the compulsion cycle looks like
How existing anxiety has been affected by trying, pregnancy, loss, or new motherhood
What ERP looks like in this specific context, paced for where you are
How to hold the very real fears that come with this season while not letting them take over
What you need to feel safer in your body, in your pregnancy, in early motherhood
I hold the personal knowledge of what this season can feel like from the inside. I don't say that to center myself in your story. I say it because I think it matters that your therapist understands not just clinically, but humanly — what it is to be in this season of life.
You don't have to go through postpartum anxiety, postpartum OCD, fertility anxiety, or reproductive mental health struggles alone.
If you are trying to conceive and the anxiety is making it harder. If you are pregnant and not able to feel present in it because the fear is too loud. If you are postpartum and the intrusive thoughts or the vigilance or the dread won't let you rest.
You deserve support. Specific, competent, clinically grounded support from someone who understands both anxiety and this season of life.
I offer perinatal anxiety and OCD therapy for women in New York City, Hoboken NJ, and Montclair NJ — in person and via telehealth across New Jersey. If you want to talk about what's going on and whether working together might be a fit, a free consultation is always where we start.
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Divya Robin, LMHC, LPC is a Columbia University-trained licensed therapist offering perinatal anxiety and OCD therapy in New York City, Hoboken NJ, and Montclair NJ. She specializes in anxiety and OCD during TTC, pregnancy, pregnancy loss, and the postpartum period bringing advanced CBT and ERP training together with deep familiarity with the reproductive mental health space.