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"Dr. Fairbrother’s work in the area of OCD, in particular her research demonstrating the high prevalence of both accidental and non-accidental harm thoughts postpartum, and the higher than currently recognized prevalence of OCD, is very helpful to me in my work with new perinatal women. Dr. Fairbrother’s findings provide a great deal of reassurance to the patients I treat and really facilitate disclosure and ultimately accurate diagnosis and treatment."
— Bryony Corbyn, MBChB, BSc, MRCPsych, Psychiatrist, Island Health

Nichole Fairbrother

Clinical Associate Professor
University of British Columbia

While completing my PhD I gave birth to my first child. I fell in love with my delightful son who is now a young adult, and the life-changing experience of pregnancy, birth and parenting. At that time I also experienced some "out of the blue" thoughts that really startled me (e.g., "I could throw my son out the window and go and make breakfast", and looking at my son's tiny fingers I thought: "They are so cute. I could cut them off with the garden clippers."). Because I knew a lot about obsessive compulsive disorder (OCD), I remember thinking... "Wow, that's so cool. I'm experiencing an unwanted, intrusive thought just like the kind that people with OCD experience and are so troubled by." I knew that 85% of adults experience these kinds of thoughts which, although unpleasant, are normal. I then began to think about what it would be like if I didn't know anything about OCD, and I was a new mom alone at night with a crying infant? That would be so frightening. Once I began asking about this phenomenon, I learned that not only had very little research been conducted in this area, but some women who reported symptoms of postpartum OCD to their care providers had had their infant removed from their care from fear that they were at risk of abusing their child.

I knew right then that I needed to study this topic and make life better for pregnant and postpartum women suffering from these kinds of thoughts. For the past 15 years, my passion has been to improve the lives of pregnant and postpartum women who are suffering from anxiety, and in particular, obsessive compulsive disorder.

Summary

Pregnant and postpartum people represent a vulnerable group in our society, with unique needs and mental health concerns. Historically, among perinatal people, depression and psychosis have received the most attention. More recently, maternal, perinatal anxiety has been receiving increased attention. This is due, in part, to recent evidence that 20% of pregnant and postpartum women suffer from one or more anxiety or anxiety-related condition. 

My primary area of study is new mothers' unwanted, intrusive thoughts of infant-related harm and the related topic of postpartum OCD. This is a poorly understood area with potential negative consequences for both mothers (child removal, OCD) and infants (separation from the mother).

Our primary objective in this work is to improve our understanding of the relationship between harm thoughts and child abuse. There is no evidence that people who suffer from OCD in general, or perinatal OCD, are at risk of acting on the content of their thoughts. In fact, OCD sufferers tend to be very ethical and tender-hearted. We also have no reason to believe that the more common postpartum, UITs of infant-related harm are predictive of maternal violence.

My motivation for working in this area is fueled by a desire to improve the mental health and well-being of new mothers who experience unwanted, intrusive thoughts of harm related to their infant and who suffer from OCD. 

Why is this important?

Despite the growing research in this area and the general conclusion that new mothers' unwanted, intrusive thoughts of infant-related harm do not represent a risk of harm to the infant, this has yet to be shown definitively. To date, no relationship between unwanted, intrusive postpartum thoughts of infant-related harm and child abuse has been found. However, sample sizes have been small, leaving some room for uncertainty and fear that women who experience these kinds of thoughts may be at risk of behaving aggressively towards their infant.  

Because of this, these types of thoughts remain a serious concern among many maternity care providers. On various occasions disclosures of unwanted, intrusive thoughts of harming one's infant have resulted in monitoring of the mother for child abuse, and/or removal of the infant. These are terrible consequences, particularly if they are unnecessary. They cause immeasurable distress to both mother and infant, and risk harming the mother-infant bond. Because many care providers continue to be concerned that unwanted, intrusive thoughts of infant-related harm may represent a risk for child abuse, we believe it is critical that we investigate this possibility, if only to rule it out.

In our new, online study, we are seeking a large sample, and will hopefully be able to provide a more definitive answer to this question. If, despite our most carefully conducted research, we are unable to find a relationship between unwanted, intrusive thoughts of infant-related harm and child harming, we will be able to educate maternity care providers about this, and significantly reduce the risks that women face when disclosing these kinds of thoughts. 

Who will benefit?

The people impacted by my work are first and foremost pregnant and postpartum people. By knowing the actual, if any, risk associated with new mothers' unwanted, intrusive thoughts of infant-related harm, we will be able to educate pregnant and postpartum women as well as their partners, care providers and family members about these kinds of thoughts. 

If, as we suspect, these thoughts are not associated with a risk of infant-harming, this will be immensely reassuring to mothers and their care-providers, and reduce the risk that women will be monitored for child abuse or have their infant removed from their care. It will also make it much more likely that women will open up about these kinds of thoughts and receive help to reduce the distress that can be associated with them. In the case that we are incorrect, and there is a risk of harm, this will also make it much clearer how to ensure both the safety and well-being of mothers and their infant.

Budget

Currently, Dr. Fairbrother is running a large perinatal mental health research lab (parlab.med.ubc.ca) with multiple projects and over 20 staff and trainees (e.g., medical undergraduate students, graduate students) without any salary support for her time. All of the 30+ hours a week which she dedicates to her research activities is on a volunteer, unfunded basis. Dr. Fairbrother's lab is highly productive with multiple ongoing research projects and over 15 manuscripts in preparation from her work. Although Dr. Fairbrother's research projects are well funded (she currently holds close to a million dollars in operating funds), she is unable to utilize these funds to support her time. Specifically, the funding agencies which support her work (primarily the Canadian Institutes of Health Research) do not permit funds to be used for investigators salary. We are seeking support for Dr. Fairbrother's time as an investigator to allow her to dedicate herself more fully to her work.