What Are Postpartum Intrusive Thoughts?
Postpartum intrusive thoughts are unwanted, distressing thoughts or that can occur after having a baby. These thoughts often involve fears of harm befalling one’s child or intentionally harming one’s child. They are sometimes accompanied by vivid images and can trigger significant anxiety, guilt, or shame.
Despite how alarming they can feel, intrusive thoughts are extremely common during the postpartum period. A 2024 study found that up to 95% of new moms reporting intrusive thoughts about accidentally harming their babies. The study also found that over 50% of postpartum mothers reporting intrusive thoughts about intentionally harming their child. So if you’re having these thoughts, you’re not alone!
Non-birthing parents can also experience intrusive thoughts. This includes partners, adoptive parents, and parents who welcome their children via surrogacy.
As this article will discuss, although postpartum intrusive thoughts can feel very scary, they do not reflect one’s true intentions or capacity to be a loving parent.
Examples of Intrusive Thoughts Postpartum
Although the specific content of postpartum intrusive thoughts varies from person to person, the thoughts are often centered on the safety and well-being of one’s baby.
Thoughts of unintentional harm
Some intrusive thoughts involve fears of accidentally harming one’s baby. For example, a parent might think, “What if I drop my baby down the stairs?” or “What if I accidentally let go while carrying them?” These thoughts can arise during everyday caregiving activities and may lead parents to become hypervigilant or to avoid certain situations.
Other common thoughts of unintentional harm include fears about not doing enough to ensure the baby’s health. Parents may worry about missing signs of SIDS (Sudden Infant Death Syndrome), accidentally exposing their baby to germs that will cause illness, or their baby choking or being unable to breathe. These types of thoughts can feel overwhelming and lead to excessive monitoring of the baby during sleep or repeated checking that the baby is okay.
Fears of intentional harm
Other intrusive thoughts involve fears of intentionally harming one’s baby. Examples include thoughts such as, “What if I stab my baby with a kitchen knife?”, “What if I violently shake my baby?”, or “What if I smother my baby with a pillow?” Thoughts like these can understandably provoke intense fear and anxiety.
Some parents also experience intrusive thoughts that are sexual or taboo in nature. These types of thoughts can feel especially upsetting because they conflict strongly with the parent’s values. As will be discussed in the next section, it is crucial to understand that, despite how frightening these thoughts can feel, they do not reflect a parent’s true desires.
Are These Thoughts Normal?
Experiencing these types of thoughts is both normal and common; as noted above, research suggests that a large majority of new mothers report experiencing unwanted, intrusive thoughts during the postpartum period. Despite how scary these thoughts can feel, it is important to understand that having such a thought does not mean that you want to or will act on it. It also does not reflect anything about who you are as a person or as a mother. In fact, one of the defining features of intrusive thoughts is that they are unwanted. The primary reason one is disturbed by such thoughts is exactly because they are horrified by their possibility and do not want to act on them.
Postpartum intrusive thoughts can be particularly challenging because they are hard to talk about or share with others. However, understanding the nature of these thoughts is important. Changing how you view them helps reduce the distress they cause.
Postpartum Intrusive Thoughts vs Postpartum Psychosis
Some new mothers who are experiencing postpartum intrusive thoughts may worry that they have postpartum psychosis. Psychosis means losing touch with reality and having poor insight into one’s symptoms. People with psychosis sometimes experience delusions (false beliefs that contradict reality) and/or hallucinations (seeing or hearing things that are not present) that they believe to be true. Psychosis carries a greater risk of harmful behavior than intrusive thoughts.
Individuals experiencing intrusive thoughts, on the other hand, are very unlikely to act on their thoughts. They recognize that their thoughts are unwanted or irrational and desperately do not want these thoughts to occur. Moreover, parents experiencing intrusive thoughts often feel intense guilt, fear, and worry in response to them. As discussed previously, it is exactly the unwanted nature of these thoughts and strong emotional response to them that tells us that these thoughts do not reflect a person’s true intentions or wishes.
What Causes Such Thoughts?
Several factors can influence or lead to the development of these types of thoughts. First, women go through significant hormonal changes after giving birth, which can affect mood and anxiety levels, and thus increase vulnerability to intrusive thoughts. New parents (birthing and non-birthing) also commonly experience sleep deprivation. Sleep deprivation is another factor that can impact mental and emotional well-being and increase your vulnerability to such thoughts.
Additionally, from an evolutionary perspective, new parents develop strong protective instincts. These can naturally lead to evaluating situations for potential threats and imagining “what if” scenarios involving harm or danger.
Finally, pre-existing vulnerability plays a role: people who already struggle with anxiety and intrusive thoughts before becoming parents may be more likely to experience postpartum-specific intrusive thoughts after having a baby.
Are These Thoughts Part of OCD?
Postpartum intrusive thoughts are a symptom, not a diagnosis. They can occur on their own, but they are also commonly associated with conditions such as postpartum anxiety and postpartum OCD.
Postpartum anxiety is characterized by excessive or uncontrollable worry about one’s baby or one’s role as a parent. For example, someone with postpartum anxiety might worry about their baby getting hurt or becoming ill or be afraid to leave their baby with another caregiver. They may experience racing thoughts, restlessness, or a persistent sense that something bad is going to happen.
As noted, intrusive thoughts can occur in the context of postpartum anxiety. For example, a parent might imagine their baby being unable to breathe and then become very worried about the possibility. They might check on their baby throughout the night or repeatedly ask their partner to confirm that the baby is okay. What distinguishes postpartum anxiety from postpartum OCD is that these thoughts and behaviors are not part of a repetitive obsession-compulsion cycle, in which compulsive behaviors or mental rituals are performed in response to the intrusive thought as a way to reduce distress or prevent a feared outcome.
Intrusive thoughts that occur in the context of postpartum OCD are considered “obsessions” and are unwanted and repetitive. In OCD, obsessions are typically followed by compulsions: mental or physical actions done in an effort to reduce the anxiety produced by an obsession.
Compulsions in postpartum situations may involve constantly checking or monitoring one’s baby to make sure they are okay, mentally replaying interactions with one’s baby to make sure nothing bad happened, or avoiding certain situations with one’s baby (doing certain things alone with them, being near dangerous/potentially harmful objects with them). Compulsions can also include looking for repeated reassurance that one is a good parent and/or won’t harm their baby from family and friends, one’s partner, healthcare providers, or the internet. While compulsions can provide temporary relief, they often prompt more anxiety in the long-run.
Treatment
One form of treatment that is particularly helpful for intrusive thoughts is cognitive behavioral therapy (CBT). CBT for postpartum anxiety helps parents identify distorted or unhelpful patterns of thinking and replace them with more balanced, realistic thoughts. It also helps reduce behaviors that increase anxiety such as excessive checking, reassurance-seeking, or avoidance of certain activities. While these types of behaviors offer temporary relief, they often strengthen anxiety by teaching our brains that constant checking is necessary to keep one’s baby safe. This prevents parents from learning that the feared outcome is unlikely to occur.
One type of CBT, Exposure and Response Prevention (ERP), is especially helpful form of postpartum OCD treatment. An experienced ERP therapist will help you identify obsessions and respond to them in a healthy way, without engaging in compulsive behaviors.
Most importantly, postpartum intrusive thoughts are highly treatable. With the right support, parents can learn to manage their intrusive thoughts in an effective way, allowing them to experience less anxiety and greater self-trust.
When to Seek Help
Increased stress and the occurrence of intrusive thoughts can be common after such a significant life change as having a baby. If your postpartum intrusive thoughts are causing unmanageable distress or anxiety, interfering with your day-to-day functioning, or affecting your ability to bond with or care for your baby, support is available. At the Manhattan Center for CBT, our therapists specialize in evidence-based treatments like CBT and ERP for postpartum anxiety and OCD, and we offer both in-person sessions in NYC and telehealth across New York, New Jersey, Massachusetts, Virginia, and Florida. Reach out today to learn how we can help you find relief and feel more like yourself again.
Frequently Asked Questions:
Can postpartum intrusive thoughts go away on their own?
Yes, postpartum intrusive thoughts can go away on their own, especially as parents adjust to their new role, stress levels improve, and sleep becomes more stable. However, when intrusive thoughts are persistent, cause significant anxiety, and get in the way of day-to-day life and caregiving activities, CBT can offer helpful tools to help reduce and manage these thoughts.
Do postpartum intrusive thoughts mean I want to hurt my baby?
No, postpartum intrusive thoughts certainly do not mean that you want to hurt your baby. In fact, these thoughts are so upsetting precisely because they are the opposite of what you want. They conflict with your values, intentions, and desires to protect your baby. Despite how scary these thoughts can feel, it is extremely unlikely that a person will act on such thoughts.
Can fathers experience postpartum intrusive thoughts?
Yes, fathers and non-birthing parents can also experience postpartum intrusive thoughts. Having a baby is a significant life change and adjustment for all parents, and can bring about increased stress, sleep disruption, and heightened concern for their babies safety and well-being. As a result, fathers and non-birthing parents can experience these same types of postpartum intrusive thoughts and can benefit from their treatment.
Are intrusive thoughts a sign of postpartum OCD?
They can be. As discussed above, postpartum intrusive thoughts are extremely common for new parents and on their own, do not necessarily indicate a mental health condition. Sometimes these thoughts accompany postpartum anxiety and are part of broader worries about real-life risks or threats to one’s child. Intrusive thoughts that are a part of postpartum OCD are unwanted or repetitive in nature and generally accompanied by mental or physical compulsive behaviors that are done in an effort to reduce anxiety or discomfort caused by the thought.
