Care of the Homicidal Patient in Pregnancy or During the Postpartum Period: Managing Intrusive Thoughts; Special Considerations for OCD

Assessing the thoughts of perinatal women around harm to others, particularly harm to their babies, is a critical part of care that needs to occur systematically and regularly. Three cases are used to illustrate common situations related to thoughts of harm to their infants. Postpartum psychosis and perinatal obsessive-compulsive disorder (OCD) both associate with thoughts of harm to the infant and both are treatable medical conditions. However, differentiating intrusive thoughts from delusions and understanding all of the contributory factors for any woman is instrumental to developing treatment plans and ensuring that mother and child are safe and healthy. Some guiding principles are outlined. This chapter also discusses cultural and legal considerations around infanticide and filicide. Finally, treatment options for clear cases of postpartum psychosis and perinatal OCD, as well as cases that are not as clear, are described including medication and therapy.