How to deal with postpartum intrusive thoughts – Advice from a therapist

Whether you’re bringing home your first or third baby, the postpartum period can rock your world. You’re physically exhausted. (Baby’s up all night and sleeps all day!) You’re mentally fried. (Exactly how do I work this pump? How am I supposed to set up a baby schedule? Did I even eat today?) And you’re emotionally walking on eggshells. (My baby cried when I was holding them—does that mean they hate me?) 

So in this time of enormous change, it’s no surprise if dark, scary, and twisted thoughts enter into your headspace. Often, these are completely normal. Everyone has intrusive thoughts sometimes. That may not make them any less disturbing—we hear that—but usually they’re fleeting and you can move on.

But if these intrusive thoughts hang on and keep nagging at you—or if they feel completely overwhelming and interfere with your life—it might signal that something more is going on. Know that you are not alone. There is good help for these types of intrusive thoughts, and you can get to a place where you feel calmer and can focus on loving and caring for your new baby. Read on to understand more about intrusive thoughts after having a baby.

What are postpartum intrusive thoughts?

Intrusive thoughts, images, sensations, feelings and/or urges are those that are unpleasant, distressing, and involuntary. And the postpartum period perfectly sets parents up to experience them. “It’s important to know that the vast majority of new parents—and not just the birth parent, but the other partner—can experience what’s considered intrusive thoughts and images regarding their newborn child. It’s common, and it’s completely natural,” says Taylor Newendorp, M.A., LCPC, Network Clinical Training Director at NOCD. 

These intrusive thoughts and images can take many forms. One of the most common is having the thought that you, as the parent, might harm your child—either intentionally or by being neglectful. You may have a sudden thought that you’re going to drop the baby. Or maybe it’s extremely grim, like what if they die in their sleep tonight? Or what if we go out in the car and get into an accident? As you can imagine, a parent can create endless distressing thoughts in their head. And most importantly, it’s out of deep love and protectiveness over your child, and not a sign that your fears may come true. 

Why intrusive thoughts happen

Why is new parenthood a prime time for intrusive postpartum thoughts? To start, there are so many changes associated with bringing home a baby. For one, your life is turned upside down. You have a new person who relies on you fully to keep them alive, and that can be scary and overwhelming. “That kicks off a natural anxiety response, priming you to be prepared for any possible situation where you may need to protect your child,” says Newendorp. 

As a result, your brain can whip up all these potential scenarios so you’ll be on guard and prepared if they randomly fall out of the stroller, roll off the changing table, or take a tumble down the stairs. In many instances, this is helpful and protective, but it’s possible for these feelings to spiral and get out of hand, rather than actually helping you keep your child safe.

In addition, there are also distinct hormonal changes that happen to both parents. In particular, there is a rather sudden drop in estrogen and progesterone for the birth parent, causing an emotional and mental whirlwind. 

And research shows that parents who didn’t give birth can experience changes in hormones such as testosterone, as well as changes in certain brain regions that aid in infant care, at the onset of parenthood, too. “We believe there is some sort of connection between these hormonal changes and the amount and frequency of intrusive thoughts and images,” says Newendorp. 

Conditions associated with postpartum intrusive thoughts

Most new parents experience the “baby blues,” which is a short period of sadness where your mood is off, you feel sad, anxious, or overwhelmed, cry a lot, and have trouble eating and sleeping, according to the Office on Women’s Health. During this time, you may be inundated with intrusive thoughts. But baby blues typically last a few days. 

If symptoms like intrusive thoughts, sadness, and anxiety hang on longer than that, you may be experiencing a mental health condition like postpartum depression, anxiety, psychosis, or obsessive-compulsive disorder (OCD). These conditions don’t “just go away” or get better on their own—they require treatment. Here’s a bit more about each of these conditions.

Postpartum Depression (PPD) & Postpartum Anxiety (PPA)

The grim cloud of postpartum depression—in all its sad, angry, hopeless, and joyless funk—is defined as sticking around for longer than two weeks after giving birth. It’s incredibly common, affecting one in eight mothers and nearly one in 10 fathers during the first year postpartum. It can take a toll on the parent, affect bonding with the baby, and put their own health and safety at risk. Postpartum anxiety is another common mood disorder in new parents, involving excessive worry that can also affect a parent’s ability to care for their baby—and themself. 

OCD

Another potential cause of excessive intrusive postpartum thoughts is OCD. This is a mental health disorder featuring obsessions, which are excessive, distressing thoughts, images, urges, sensations and/or feelings. They’re followed by compulsions that involve repetitive mental or physical behaviors that are done to neutralize the anxiety that obsessions create, or to prevent something bad from happening. 

OCD shows up in various subtypes or themes, and one of them is postpartum OCD, something that may affect 7% of women who’ve given birth. That stat is higher than past studies, suggesting that postpartum OCD is more common than previously thought. In this type of OCD, obsessions center around your baby. You may be concerned about germs that could make them sick, fear that you’ll make a mistake that will put them in harm’s way, or worry that you will intentionally hurt them. That can lead to certain obsessions like excessively checking in on your baby, constantly washing your hands and wiping down any surface your baby might touch, or continually seeking reassurance from others or online about your baby’s well being. 

Again, having these fears occasionally is normal, but where it crosses a line into OCD is when those intrusive thoughts become frequent, extreme, or if they interfere with your life. “If you have OCD, you might notice these thoughts are happening almost all of the time and causing a very intense, anxious reaction,” says Newendorp.

Another sign is if you begin withdrawing from your child. “In postpartum OCD, we sometimes see a parent disengaging from their child and avoiding their child out of fear,” he explains. What happens is that you interpret your intrusive thoughts as having meaning—perhaps you fear that you’re a danger to your child—and you may start to believe them. 

For example, take fleeting thoughts like, What if I molest my baby when I change them? Or I might hit them when they cry. ”A parent without OCD might think to themselves, Wow, that was a weird and disturbing thought and then move on with their day. On the other hand, someone with OCD might latch onto that intrusive thought and worry that it’s proof that they’re capable of acting in that way. 

This causes even more distress—because the last thing someone with postpartum OCD wants is to actually be away from their child. They want to be there to lovingly care for their child at each moment, but the extreme fear that they could be responsible for something bad happening keeps them away from their baby. 

OCD is an extremely opportunistic disease, in that it loves taking exactly what you most care about and using it against you. You love your child and want nothing bad to happen to them, so OCD sweeps in to tell you that you can keep your child safe if you just perform the compulsions it wants you to—but this isn’t true, and it only makes your fears grow stronger. 

Postpartum Psychosis

This rare and severe mental illness is extremely dangerous for both baby and parent, involving a loss of touch with reality, paranoia, delusions, and hallucinations. About one to two people per 1,000 may develop postpartum psychosis in the first six weeks after giving birth. 

Postpartum psychosis is a mental health emergency because it affects a parent’s sense of reality, according to the Cleveland Clinic, and therefore increases the risk of suicide and/or harming the infant. However, it’s difficult for the parent experiencing it to understand that something is wrong. To ensure everyone is safe, immediate inpatient treatment is needed, and often this is arranged by family members or loved ones who notice these disturbing changes in a parent. 

Treatment for postpartum intrusive thoughts

If you are experiencing distress due to intrusive thoughts, there are really great options available to help you. Start by consulting with the medical team who helped deliver your child. “If you’ve given birth in a hospital setting, the vast majority of hospitals now have social workers and counselors on staff who are familiar with postpartum depression and anxiety, as well as OCD,” says Newendorp. Another option is speaking with your child’s pediatrician or your ob-gyn. 

It can be scary to open up in this way, as you may worry about how it will be perceived. However, these medical professionals are well-versed in postpartum intrusive thoughts and can help direct you as to where to take the next steps for a diagnosis and treatment. They are there for you and understand the struggles of parenthood.

Getting an accurate diagnosis is so important, as it will guide the treatment that’s appropriate for you. For example, postpartum depression or anxiety can be treated with therapy, support groups, and/or medication. 

However, for OCD, traditional talk therapy can actually make the condition worse. You’ll want to seek out a therapist who has specialized training in treating OCD, particularly with a form of therapy called exposure and response prevention (ERP). It was developed specifically to treat OCD, and is clinically proven to be highly effective in the majority of people.

While general forms of talk therapy can lead to great results for many types of mental health issues, they don’t work for OCD, and can even contribute to a vicious cycle of obsessions and compulsions, causing OCD to get worse over time. For example, imagine you’re having intrusive thoughts about getting angry and hurting your baby while they’re crying. A general talk therapist might work with you in sessions to dig deeper into why you’re having these thoughts, or try to help you understand that you would never actually harm your child. 

Unfortunately, OCD won’t accept this reassurance, and you’ll end up chasing 100% certainty about your fears, only for OCD to spread doubt again: “But what if you’re wrong? After all, you can never be completely sure.” That’s because seeking reassurance actually becomes a compulsion, and it makes your fears worse. In ERP, on the other hand, you’d work on strategies to stop compulsions like reassurance-seeking, and learn to sit with your anxiety and discomfort. Maybe you say to yourself, “Yes, it’s technically possible that I could hurt my child. But I’m going to love and care for them the best I can.”

Working with an OCD specialist to address the thoughts and situations that cause you distress is more accessible than ever thanks to virtual ERP therapy. “The great thing about teletherapy is that the therapist can be ‘in the room’ with the parent and new child to coach them along,” says Newendorp. 

And, as a busy new parent, it can be so much more convenient than in-person treatment. You will also be given skills that you can use outside of the therapy setting so you feel confident on your own.

“When you use ERP to slowly push through your anxiety, you’ll start to learn that your fears don’t come true,” says Newendorp. And that eventually teaches your brain that there’s no emergency, and allows you to manage your OCD symptoms. The result is that you’ll be able to truly enjoy spending time with your baby again—and that’s really what’s most important.