Postpartum intrusive thoughts: What they are and how to cope

You’ve just had a baby and you thought you’d feel calm and cuddly, so happy to sit on the couch and stare at your new little one. There are those happy moments, of course, but also, you’ve found you’re having unwanted and uncontrollable thoughts, sometimes about harm coming to you or your baby. Is this normal? 

Yes, it is. Postpartum intrusive thoughts are incredibly common. Some research finds nearly all postpartum women experience them. Here’s more on why they happen, how to deal, and when to know if you need more support with your mental health.

About postpartum intrusive thoughts

What are intrusive thoughts?

Intrusive thoughts are scary or disturbing thoughts that may feel out of your control. It may feel like they come into your mind unprompted. Intrusive thoughts can conflict with your normal daily thoughts and feelings and be very distressing. 

Examples of intrusive thoughts postpartum 

Postpartum intrusive thoughts can be disturbing, strange, outlandish, scary and more. Unwanted thoughts after giving birth are often related to harm coming to you or your baby.

For example, you might imagine yourself dropping your baby when you go up and down the stairs in your home. Or you might imagine that you suddenly have a heart attack in the middle of the night and no one is there to care for your baby. 

They can be related to a fear of bodily harm, emotional difficulty, or situations that arise suddenly. Postpartum thoughts can also be related to anxiety around feeding, breastfeeding, or other aspects of caring for your baby. 

Intrusive thoughts can also contribute to compulsive actions, like repetitive checking on your baby.

Causes and contributing factors 

It is unclear exactly what causes intrusive thoughts in the postpartum period. Pregnancy and the weeks after birth are times of intense change for your body, hormones, and emotions. You are adjusting to so much, and the large hormonal shifts alongside very real lifestyle changes may predispose you to intrusive thoughts. Sleep deprivation and the realities of taking care of a newborn can play a role, too. 

The good news? They don’t last forever! Postpartum intrusive thoughts usually peak around 5-6 weeks after giving birth and for most people, they decrease or completely resolve by 6 months after birth. 

Impact of postpartum intrusive thoughts

Despite how normal and temporary they might be, that doesn’t mean it’s easy to have intrusive thoughts after birth. They can have a real impact on your emotions and daily life, as well as your mental health as a new mom. 

For example, you might find these thoughts very distracting and hard to overcome. You might feel shame, guilt, or even like a bad mom for having intrusive thoughts (despite the fact that they are beyond your control). Some people may even develop thought-action fusion, which is a symptom of obsessive-compulsive disorder where they believe their thoughts are essentially the same as actions. 

Coping with postpartum intrusive thoughts 

There are so many supportive ways you can cope with intrusive thoughts during your postpartum period. 

Cognitive behavioral therapy (or CBT) is an evidence-based way to deal with these thoughts and start to feel better. Much of the research on specific improvements in postpartum intrusive thoughts and anxiety is focused on online CBT-based workshops or support groups, which are accessible options for new parents who may not be able to leave the house. 

There are also simple things you can do in your everyday life, like focus on mindfulness and grounding practices that keep you in the moment and remind you that your thoughts are just thoughts. Other strategies, like Emotional Freedom Techniques (EFT, also known as tapping), can help, too. 

It’s also important to let the people in your life know what you are experiencing so they can support you (and provide help if and when you need more professional support). Doulas, partners, and other family members all fall into this category. If you are already working with a therapist or psychiatrist, you should let them know about your postpartum intrusive thoughts, as well. 

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Postpartum intrusive thoughts and OCD

Postpartum intrusive thoughts can be connected to postpartum obsessive compulsive disorder (OCD). In fact, mothers and parents who already have OCD are more likely to experience intrusive thoughts after having a baby. There are some real differences in the conditions, though.

Clinically-normal postpartum intrusive thoughts:

• Unwanted and/or distressing thoughts
• Knowledge and awareness that thoughts are irrational and unwanted
• Anxiety or worry about the thoughts
• Precautions taken to prevent actual harm to self or baby

Postpartum OCD symptoms:

• More time-consuming and impactful obsessions
• Significant compulsive behaviors (checking, reassurance-seeking, avoidance)
• Greater effect on every day life (aka impacting the ability to about daily tasks or routines)
• May include contamination fears, aggressive obsessions, and cleaning/checking compulsions

Treatment options 

If you have postpartum OCD, the first-line treatment is usually cognitive behavioral therapy (CBT), often including exposure and response prevention (ERP). ERP involves gradual exposure to fearful thoughts or situations while also working to prevent compulsive actions. It can help break the overall cycle of fear and anxiety. 

Psychiatric medications, like selective serotonin reuptake inhibitors (SSRIs), are another option that can work well. 

When to seek support

Having intrusive thoughts after giving birth is very common, but it’s still important to understand when these thoughts become a problem that warrant more help. The line isn’t obvious and sometimes, parents end up suffering in silence. 

In general, if you find that your scary thoughts are taking up significant time, energy, and resources, that’s a sign that you should reach out for mental health support. The same goes for if you are avoiding or changing your normal activities (like driving or seeing friends) because of your thoughts, or if you develop compulsive rituals around you or your baby’s routine or safety. Other signs include feeling disconnected from your baby, thoughts of harming yourself, and physical symptoms of anxiety, like racing heart, inability to sleep, or difficulty breathing. 

If you find that you are experiencing these signs and symptoms, especially for two weeks or longer, contact your doctor, midwife, psychiatrist, or therapist right away. You can get help to feel better. 

Comparisons

Postpartum OCD vs postpartum anxiety

Intrusive thoughts are a key symptom of postpartum anxiety, but having them doesn’t mean you necessarily have either postpartum anxiety or postpartum OCD. In general, postpartum anxiety includes excessive worry and intrusive thoughts without compulsive behaviors, while postpartum OCD includes intrusive thoughts with compulsive behaviors. In both conditions, the mother or parent realizes that the thoughts are irrational.

Postpartum OCD vs postpartum depression

Postpartum OCD and postpartum depression often occur at the same time. Up to 43% of women with postpartum OCD also have depressive symptoms. Still, they are different clinical disorders. Postpartum depression symptoms center more on persistent feelings of sadness, while postpartum OCD is focused more on intrusive thoughts (including ones about harm coming to yourself or the baby) and compulsive behaviors. If you have both conditions, they can both be treated successfully at the same time.

Postpartum OCD vs postpartum psychosis

The main difference between having postpartum OCD and postpartum psychosis is that when you have postpartum OCD, you understand that the thoughts and behaviors you are experiencing are irrational. When you have postpartum psychosis, you do not. Postpartum psychosis also can include hallucinations or delusions. 

Postpartum psychosis is also much more rare, affecting about 0.1-0.2% of birthing women in the population, while postpartum OCD occurs in anywhere from 11-31% of postpartum women. 

FAQs about postpartum intrusive thoughts

How long do postpartum intrusive thoughts last?

It’s different for everyone, but you should know that they do not last forever. Postpartum intrusive thoughts usually peak around 5-6 weeks after giving birth and they often decrease or completely resolve by 6 months after birth. 

Are intrusive thoughts normal?

Yes! Intrusive thoughts in the postpartum period and after giving birth are actually incredibly common and normal. Some research estimates these thoughts occur in 96-100% of new mothers. 

Does postpartum OCD go away?

Postpartum OCD is a more serious clinical condition and people with postpartum OCD will also have experience intrusive thoughts. Postpartum OCD usually peaks around eight weeks after birth and then decreases. If you are diagnosed with postpartum OCD, it can be treated with cognitive behavioral therapy, medications like SSRIs, and exposure therapy. So yes, it is possible for it to go away! 

How to help someone with intrusive thoughts

The most important way to help someone with postpartum intrusive thoughts is to listen to them and normalize the experience they are having. If they express guilt, shame, or feelings of being a bad mom, point out to them all of the wonderful and caring things you see them doing as a parent. Show up for them in different ways, including helping with baby care or life logistics, encourage them to get help if needed and let them know they're not alone in this experience.