You’re Not A Bad Mom If You Have Intrusive Thoughts

If you’re a new parent and you’ve ever had a scary image flash across your mind — the glint of a knife in the kitchen triggers a scary vision, perhaps, or the thought of carrying your baby down the stairs suddenly feels dangerous — you’ve experienced an intrusive thought. You are not alone. In fact, intrusive thoughts in the postpartum time period are very, very common. That doesn’t make them any less uncomfortable, but at the very least you are far from alone. We spoke to perinatal mental health experts to find out everything new parents — and the people who love them — urgently need to know about intrusive thoughts, from exactly how they are defined to how common they are, how to talk to your partner about them, and how to seek help if intrusive thoughts are interfering with your daily life.

What exactly is an ‘intrusive thought’ during the postpartum period?

“Intrusive thoughts are distressing. They're scary thoughts — and they can also sometimes be images — that are unwanted,” says Dr. Jacquelyn Knapp, Assistant Professor of Obstetrics and Gynecology and Assistant Professor of Psychiatry at Oregon Health and Science University School of Medicine.

Scary, intrusive thoughts are so common, says Paige Bellenbaum, a licensed clinical social worker and founding director at the Motherhood Center, that they’re not even “always indicative of that woman having a PMAD [Postpartum Mood and Anxiety Disorder]. It’s just that common.” She and many perinatal mental health specialists recommend Karen Kleiman’s book Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers as a gold standard in terms of normalizing conversations around the intrusive thoughts that so often come along with new motherhood. It’s a book that Bellenbaum believes every new parent should have within easy reach as they adjust to life as a caretaker.

Examples of common intrusive thoughts

While everyone has a slightly different experience with new parenthood, Bellenbaum says that certain images and themes come up again and again in many people’s postpartum intrusive thoughts. Thoughts like:

• I’m afraid to get near the stairs because I’m afraid I might accidentally throw my baby down the stairs.
• I’m afraid to get near the window, because I think I might throw my baby out the window.
• I don't want to go into the kitchen because I’m afraid I am going to put my baby in the microwave.
• I don't want to go into the kitchen because I’m afraid that a knife is going to jump into my hand and I’m accidentally going to stab my baby.
• I can’t go outside and push the stroller because I have a graphic image of having us both hit by a car, and I see my baby all over the street.

Oftentimes, mothers and birthing people that experience intrusive thoughts like these have a powerful sense of guilt and shame around having the thought, and end up fearing the thoughts themselves, says Bellenbaum. “They wonder, what kind of a mother would ever think about something like that happening to their own baby? But it’s extremely common,” Bellenbaum assures. “Most mothers have something called a ‘scary intrusive thought.’”

Are intrusive thoughts normal after pregnancy?

Yes! So normal. Postpartum intrusive thoughts are very common, even more common than the baby blues, Bellenbaum tells me. It’s estimated that about “80% of all new mothers experience an intrusive thought,” she says. However, because of the shame and guilt that so often accompanies these scary images, many people don’t talk openly about their experience. This silence perpetuates the isolation that new parents feel when they experience an intrusive thought. But, perinatal mental health care providers are working to normalize the idea that most new moms will have an intrusive thought at some point during their postpartum experience. Usually for these kinds of difficult, disturbing thoughts, “the most common peak is around eight weeks postpartum,” says Knapp.

“Many women will go through their entire life as a mother having had these very gruesome, graphic, intense, repetitive, scary, distressing thoughts of harm coming to their baby — and often them being the ones that are causing the harm — and never know just how common it is,” says Bellenbaum.

What to do if you’re experiencing intrusive thoughts postpartum

First, know that you’re not alone. What you’re experiencing is something that many, many birthing people have experienced, too. But just because your experience is not unique does not mean it’s not scary and worthy of attention. Once you’ve realized you’re facing something many other parents have faced, both Bellenbaum and Knapp encourage you to reach out to anyone you feel comfortable talking to about this, and ask for help. “Do not struggle alone,” Knapp urges. “These thoughts can really get in the way of being able to be present with their babies and be the parent they want to be.”

A simple way to start the process of seeking some supportive care is to simply reach out to either your obstetric provider — especially since you’re often still in close contact with them in the first weeks postpartum — or primary care provider, Knapp suggests. A midwife or postpartum doula should also be able to offer both a sympathetic ear and resources for support.

“Sometimes moms might get met with oh, that's just common new mom anxiety,” says Knapp, which can feel dismissive. She notes that an OB-GYN or primary care doctor may not be well-versed in even common postpartum mental health challenges like intrusive thoughts. “In that case, I would continue to explore options, and look into seeing a mental health provider,” she adds.

When you are caring for a newborn, it may feel overwhelming to even think about picking up the phone. Both Knapp and Bellenbaum urge people who are struggling with intrusive thoughts to talk to a partner or close friend about their struggles, as they may be able to help you reach out to the appropriate support networks.

How & when to seek more support if you’re feeling overwhelmed

Because intrusive thoughts are quite common, it may be difficult to know where the line is between what’s normal and what might be indicative of a true perinatal mood and anxiety disorder, like postpartum OCD, which would benefit from professional treatment and support. How can a person know when should you like raise the flag and reach out to someone to say “I’m having intrusive thoughts and I’m not really OK.”

“The word that we use in medicine is when there's ‘functional impairment,’” Knapp explains. Red flags to watch for, according to Knapp, are:

• If the thoughts are preventing you from sleeping when your baby is sleeping
• If you feel like you’re unable to connect or be present with your baby or enjoy time with their baby
• If you’re constantly getting really irritable with your partner
• If intrusive thoughts are so severe that you are unable to allow others — sometimes even your spouse — to care for your baby.

“If you have this mindset that only you can keep them safe, you’re going to need some relief,” Knapp explains. “We want to switch the narrative from moms being self-sacrificing and thinking that only they can do it, because it takes a village. If you're not allowing the village to help you, you’re going to feel burnt out.”

No matter what degree of struggle you’re experiencing, know that there’s a lot of support out there, from other parents who have been there, to local perinatal mental health care specialists. Your OB-GYN or health care provider should be able to help you find someone with a specialty in maternal mental health care. Both Bellenbaum and Knapp also suggest reaching out to Postpartum Support International, which is a national organization with a 24/7 crisis line, as well as free online support groups.

Why do I get intrusive thoughts about my baby?

It still isn’t known why so many new mothers and birthing people experience intrusive thoughts. However, while doctors and researchers don’t know the exact causes, the phenomenon is rooted in biological processes that researchers can identify, Knapp explains. It is normal for mothers to be protective of their babies. “We see these same changes in other animals. We have an imaging study that’s shown changes in the maternal brain that likely have an adaptive value for moms to recognize danger and perceive potential threat to their babies,” Knapp says. MRI studies have also found changes in the maternal brain where areas that are correlated with social cognition expand while other areas decrease in volume. “It’s believed that this is an evolutionary process, so that you can readily perceive threat, and have a recognition of when your baby's in distress, perceive their facial cues if there’s some sort of threat occurring. So it’s [intrusive thoughts postpartum] probably related to that.”

Postpartum changes in the maternal brain actually look a bit like what happens during adolescence, when there’s “a significant number of brain changes called synaptic pruning,” Knapp explains. While this all begins to get really technical really fast, it may be comforting to know simply that there are very real, physiological and neurological changes that are happening to new mothers that are likely the cause of the intrusive thoughts. You’re not a bad mom or birthing person for having them — you’re simply a normal, new parent.

You’re not alone, this is normal, this will pass, and there is real help and great treatments available, if you need them. If you are struggling, don’t hesitate to talk to someone — there are many people who will understand, and many people available to help you through.

If you or someone you know is experiencing depression or anxiety during pregnancy or in the postpartum period, contact the Postpartum Health Alliance warmline at 1-888-724-7240 or Postpartum Support International at 1-800-944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255 or dialing 911. For more resources, you can visit Postpartum Support International.

Experts:

Paige Bellenbaum, LCSW, Founding Director and Chief External Relations Officer

Dr. Jacquelyn Knapp, M.D., Assistant Professor of Obstetrics and Gynecology, School of Medicine and Assistant Professor of Psychiatry, School of Medicine, Oregon Health and Science University