“I’m having disturbing postpartum thoughts. What could be going on?”

Having a baby is life-altering. Everyone knows that. Whether you’re bringing your first baby home (or second, or third), it’s a whirlwind of major postpartum hormone changes, as well as feedings and diaper changes and sleepless nights, not to mention the pressure of being fully in charge of the safety of another human being.

And that can be scary.

So scary, in fact, that all of the ways your baby could get hurt may pop into your head—one right after the other. What if they squirm out of the stroller and end up on the ground? What if their little sniffle means they have RSV and need to go to the hospital? Are they actually still breathing during nap time? Will their lovey suffocate them? What if you suddenly burned them–even on purpose–with your curling iron?

These can each be described as intrusive thoughts. But take a deep breath for a moment here, because they’re often totally normal—and common—even the ones that may be dark and make you worry about yourself as a parent. The question is how often you struggle with postpartum intrusive thoughts, and the extent to which they may be interfering with your life and your ability to be the parent you want to be.

Here’s what you need to know about why these thoughts might be happening, and clues that you should seek help.

What is an intrusive thought?

It’s normal to have a ticker-tape of thoughts as you go about your day. Some of these thoughts, images, or urges seem to barge in—out of nowhere—and make you feel uncomfortable. These are intrusive thoughts, says Monique Williamson, LMFT, a licensed therapist with NOCD. Intrusive thoughts can be about anything—you, a loved one, a child, a stranger on the street—and the majority of people have them occasionally.

Some people can brush them off (I know I don’t actually want to drown my dog–I love my dog!), but others get stuck trying to figure out what these thoughts mean, and how to stop them. Interestingly, the more attention you give these intrusions, the stronger and more frequent they tend to become.

What are postpartum intrusive thoughts?

A postpartum-intrusive thought is an uncomfortable idea that occurs in the time after childbirth and tends to involve your baby. And just like intrusive thoughts during any other time of life, they may be extremely disturbing. As Brown University researcher Katherine A. Mason, PhD, describes in a 2023 article in the journal Anthropology and Humanism: “These thoughts can include horrific flashes of violence involving one’s baby and frequently lead to shame and fear on the mother’s part, but rarely result in real-world violence.”

Dr. Mason spent a lot of time speaking with women struggling with their mental health postpartum on a healthline. The thoughts and images that these moms confessed to having would shake anyone to their core, but she reassured them that they didn’t mean they were going to hurt their baby. “They are just thoughts,” she’d say.

While postpartum intrusive thoughts, along with postpartum depression and anxiety may mostly focus on the mother’s experience, it’s worth pointing out that fathers can have them, too. For example, research has found that nearly one in 10 dads experience postpartum depression, and may have similar triggers to a mother with OCD.

Postpartum intrusive thoughts don’t always center on images or urges that you’ll harm your baby. They can be about something bad happening to them, such as your infant rolling off the changing table, stopping breathing during sleep, or being accidentally or purposefully hurt while in the care of someone else.

What scares parents with postpartum intrusions the most is that these thoughts say something about what they might do if they had the chance—that they may actually be capable of harming their baby. (Again, it can be the total opposite of reality, but it may still feel very distressing.)

Another distinction to make is that postpartum intrusive thoughts are not the same as a postpartum psychosis, a rare mental illness that leaves parents out of touch with reality and suffering from delusions, paranoia, and hallucinations, according to StatPearls. This condition is a medical emergency because the parent can be a danger to themselves and their child.

Why am I having postpartum intrusive thoughts?

Postpartum depression and postpartum anxiety can cause intrusive thoughts. But obsessive-compulsive disorder (OCD) can also sneak its way in postpartum, says Williamson. And it makes complete sense as to why: “We want to feel safe. As a new parent, your biggest priority is making sure you’re keeping your baby alive, and that can be stressful,” she says.

OCD is a disorder that attaches to the things you care about most and creates obsessions around them. But OCD lies to you, because it promises that it holds the answers to keeping you and your family safe by practicing compulsions.Yet it never does, OCD is never satisfied.

But we’re getting a little ahead of ourselves. Let’s back up for a minute and look at what OCD is. It’s a mental health disorder that features a cycle of obsessions—intrusive thoughts, images, sensations, feelings and/or urges that are unwanted and distressing. They’re followed by compulsions, which are mental or physical behaviors, such as checking, ruminating, avoiding, and reassurance-seeking, that are done to neutralize the distress of an obsession and/or prevent something bad from happening.

In the postpartum period, an intrusive thought might be something like What if my baby stopped breathing after I put them down for bed. You’d then go check and watch the rise and fall of their chest. You feel better. But that anxiety swiftly comes back. Now you’re worried that they squirmed out of their sleep sack and put it over their head. So you check the baby monitor. Everything looks fine, but you go in again to do the breathing test. And that cycle of obsession (intrusive thought) and compulsion (checking) persists.

It’s worth repeating that OCD likes to latch onto and attack the things that you love or value the most. In this case, Williamson says, it’s your baby—and your world revolves around making sure they grow up loved and cared for and safe.

So how do you know if you’re just a nervous parent, or if it could be OCD? In some cases, your intrusive thoughts may have appeared before your baby was even born. Consider how much time you have dedicated to your obsessions and compulsions. “In isolation, worrying about your child not breathing in the night, or falling off the changing table are not compulsions in OCD. But as the need to perform compulsions—constant checking—increases, that’s when you might slide into OCD behaviors,” she explains.

When to seek help

Postpartum OCD isn’t often talked about in the media, but recently reality star Scheana Shay of Vanderpump Rules opened up about her experience after the birth of her daughter, Summer Moon. She called it terrifying, and “a battle every day.” That’s why if intrusive thoughts and compulsions are causing you distress to the point that it’s disrupting your life, or you’re not sure if these intrusions or your responses to them are normal, you should reach out to a therapist who specializes in OCD.

Despite the lack of general awareness, postpartum OCD isn’t a rare condition. One study in The Journal of Clinical Psychiatry of 763 moms found that about 9% qualified for postpartum OCD. The researchers pointed out that it’s more common than was previously believed, and that clinicians should specifically ask about OCD symptoms during postpartum appointments.

Because it’s not the standard of care, it’s important to be upfront about your symptoms so that the practice or hospital can direct you to getting the diagnosis and care you need.

And if you’re a loved one who is reading this, know that it can be difficult for postpartum parents to know when something is wrong—especially when everything feels new, different, and even rightfully scary. So it may help to open up dialogue about your concerns with them.

While it’s important to remember that the existence of intrusive thoughts does not mean that you are going to harm your baby, they can affect your ability to bond with them. If these intrusions scare you and, say, you obsess over whether they really mean that you’re a monster, you may even avoid being around your child or parenting them alone.

At the very least, you may not be able to enjoy the small, beautiful moments, like snuggling on the couch because—bam—an image of you falling asleep and suffocating them pops into your mind. You deserve to live a full life with this family you’ve created, rather than feel as if you’re held tight by intrusive thoughts and OCD.

Finding the right treatment

For intrusive thoughts themselves, Williamson recommends working with a licensed therapist to distance yourself from the thought—my baby will get attacked by this dog on a walk—by naming it as a thought, and acknowledging that all thoughts do not have to be true or mean anything.

Next, you’d work with your therapist on risk acceptance. You’re not guaranteed safety everytime you leave the house. That’s not accepting that something bad will happen to your baby, only that you don’t have control over everything—all you can do is your best, she says. This is a process that doesn’t happen overnight, but with work and the right expert guidance, you can help your mind move on from these thoughts, and onto spending time with your baby.

If you are diagnosed with postpartum OCD, treatment can help make your day-to-day life easier and more enjoyable with your child. The most successful is a form of behavioral therapy called exposure and response prevention (ERP). It was developed specifically to treat OCD—is clinically proven to be highly effective in the majority of people. (And it’s very different from the standard talk therapy you might be familiar with, which can actually make OCD worse.)

Here’s how ERP works: A trained therapist who specializes in OCD will take the time to understand your symptoms and create a custom ERP therapy plan specifically for you. Then, you’ll work together to rank your fears or triggers based on how stressful they seem. To begin with, your therapist will typically prompt you to face a fear that brings on only a mild amount of distress.

For example, that might be looking at an image of a changing table. The fear thoughts—like the idea that your baby will roll off of it during a diaper change—will likely come up, but instead of responding with a compulsion, you’ll learn to tolerate the discomfort. By making this conscious choice and seeing that nothing bad occurs, or realizing that you handled the discomfort better than you thought you could, your brain gets the message that there was nothing to fear in the first place.

How virtual therapy may help

As a new parent, it can be tough to find the time to leave the house to attend a therapy appointment. But virtual therapy has made that more accessible than ever. In fact, peer reviewed research shows live teletherapy sessions of ERP can be more effective, delivering results in less time than traditional outpatient ERP therapy, often in as little as 12 weeks.

Finding a community of people who understand postpartum intrusive thoughts and OCD can also help you along your treatment journey, says Williamson, who recommends that the people she works with seek out support groups. “It’s so good to hear the experience others have. You’ll notice that you have empathy for these other people, which can help you develop empathy for yourself in light of these intrusive thoughts.”