How women with obsessive compulsive disorder experience maternity care and mental health care during pregnancy and postpartum: A systematic literature review.

INTRODUCTION: Obsessive Compulsive Disorder has a higher prevalence in pregnancy and postpartum than in the general population. Experiences of maternity care and mental health care can impact the health and wellbeing of perinatal women. The aim of this review was to synthesize evidence on the experiences of maternity care and mental health care for women with OCD during pregnancy and postpartum. METHODS: Studies were systematically reviewed by two independent reviewers after identification in MEDLINE, Embase, PsycINFO, Global Health, CINAHL, the Cochrane Library, Web of Science and grey literature searches (last searched October 2021). Papers meeting pre-specified inclusion criteria were extracted using a pre-determined extraction sheet and were quality assessed. Thematic synthesis was conducted. RESULTS: 19 papers reporting 18 studies describing 33 participants were included. Three descriptive themes were found: experiences of barriers to treatment and care, experiences of treatment/care decision making and experiences of treatment and care. Three analytic themes were found demonstrating tensions: keeping baby healthy vs keeping mother healthy, keeping baby safe vs keeping mother safe, and normal perinatal experience vs not normal perinatal experience. LIMITATIONS: Despite an inclusive search strategy, available data was limited. 17 of the studies were case studies that were poor in quality. Synthesis and subsequent findings were limited. CONCLUSIONS: There were significant literature gaps for all aspects of care but particularly around experiences of maternity and pharmacological care. Tensions that could impact the experience of care need to be carefully balanced to ensure that women with OCD get the care that they need.