Postpartum Intrusive Thoughts

Written and Fact-Checked by: Jenna Carberg

Scary Thoughts After Having a Baby Are Common

Maybe it’s a sudden image of dropping your baby down the stairs. A flash of your baby not breathing. An unwanted thought of hurting your baby that makes you feel sick just for thinking it. These are called intrusive thoughts, and if you’re having them, you are far from alone.

Research shows these thoughts are extremely common in new parents. According to the American College of Obstetricians and Gynecologists (ACOG), unwanted or intrusive thoughts, including thoughts of harming the infant, “are very common and are often related to fears of something happening.” Having them does not mean you are a bad parent or that you want to hurt your baby.

How Common Are Intrusive Thoughts?

In a study of 763 women in British Columbia followed from pregnancy through the first months after birth:

  • 95.8% had unwanted thoughts of accidental harm coming to their baby.
  • 53.9% had unwanted thoughts of intentionally harming their baby.
  • The thoughts were most intense in roughly the first 8 weeks, when more than 40% of women felt moderate or extreme distress about them.
  • For most, the thoughts became less frequent or went away by 6 months.

An earlier study found thoughts of accidental harm were universal among new mothers, and nearly half had unwanted thoughts of intentional harm. Higher parenting stress and low social support made the more upsetting thoughts more likely.

Fathers can have intrusive thoughts too, though there’s little research on how common they are in dads.

Common Types of Intrusive Thoughts

  • Accidental harm: the most common are thoughts of the baby suffocating or dying of sudden infant death syndrome (SIDS), or of dropping the baby.
  • Intentional harm: unwanted images or urges of hurting the baby. The most commonly reported involved neglect.
  • Other upsetting content, including thoughts that feel taboo or disturbing. These can be especially hard to talk about.

Thoughts of accidental harm tend to happen more often and take up more time, while thoughts of intentional harm tend to be more distressing.

Does Having These Thoughts Mean I’ll Act on Them?

This is the most important thing to know. ACOG states: “Most women who find these thoughts distressing (ie, ego dystonic) will not act on them; as such, there is low risk of infant harm.”

“Ego-dystonic” means the thoughts feel wrong, unwanted and upsetting to you. The fact that the thought horrifies you is a sign that it goes against who you are.

Research backs this up. In a study of 388 new mothers:

  • Women who had unwanted thoughts of intentionally harming their baby were no more likely to behave aggressively toward their baby than women who didn’t have those thoughts.
  • The same was true for women with postpartum OCD.

ACOG notes that intrusive thoughts can happen without any mental health condition, but they’re also associated with postpartum depression, anxiety and obsessive-compulsive disorder (OCD). They “merit further inquiry and evaluation,” meaning they’re worth talking about with a provider, especially if they’re frequent or distressing.

Intrusive Thoughts vs. Postpartum Psychosis

Intrusive thoughts are sometimes confused with postpartum psychosis, a rare but serious emergency that affects 1 to 2 of every 1,000 births. The key difference is insight:

Intrusive thoughts Postpartum psychosis
How the thoughts feel Unwanted, upsetting, “not me” May feel real or justified
Insight You know the thoughts don’t make sense and don’t want them Limited or no insight into symptoms
Other symptoms Often anxiety, worry, checking or avoidance Hallucinations, delusions, confusion, severe insomnia, a dramatic change from usual behavior
How common Very common Rare
Urgency Worth discussing with a provider Medical emergency

Postpartum OCD

When intrusive thoughts become frequent, very distressing and lead to repeated behaviors to feel safe, it may be postpartum OCD.

  • In the British Columbia study, about 7% of women had OCD at any given point after birth, with a peak near 9% around 8 weeks. About 9% developed OCD for the first time by 6 months postpartum.
  • Postpartum OCD more often involves thoughts of harm and less often involves cleaning compulsions than OCD at other times.
  • Common behaviors include checking on the baby repeatedly, avoiding being alone with the baby or avoiding bathing or knives, and seeking reassurance from yourself or others.

Why Checking and Reassurance Can Backfire

Checking, avoiding and asking for reassurance bring short-term relief, but they can teach your brain that the thought was dangerous, which keeps the cycle going. In research, how strongly women reacted to harm thoughts shaped how much the thoughts took over their time and interfered with parenting. Beliefs about what intrusive thoughts mean also predicted later OCD symptoms.

Treatment That Works

  • Cognitive behavioral therapy with exposure and response prevention (ERP) is a first-line treatment for postpartum OCD. ERP helps you face feared thoughts and situations gradually without doing the checking or avoiding, so the fear fades over time.
  • SSRIs such as sertraline or escitalopram are ACOG’s first-line medications for perinatal anxiety and related conditions, including OCD, and are compatible with breastfeeding for most people. See antidepressants during pregnancy and breastfeeding.
  • Learning that the thoughts are common is itself helpful. Researchers who studied these thoughts called for more education to normalize them and reduce distress.

Evidence specific to the postpartum period is still limited, and treatment follows what works for OCD and anxiety in general. See postpartum anxiety treatment.

Find a therapist experienced with postpartum OCD and intrusive thoughts

Talking to Someone About Your Thoughts

Many parents keep these thoughts secret out of shame or fear of what others will think, and clinicians note that shame is one reason postpartum OCD goes undiagnosed. Talking to a provider who understands perinatal mental health is how you get an accurate evaluation and relief.

ACOG’s guidelines encourage clinicians to ask directly about intrusive thoughts, which means these conversations are a normal part of perinatal care. It can help to say: “I’m having scary, unwanted thoughts about my baby that I don’t want to have.” Look for a clinician with perinatal training, such as PMH-C certification.

A Book Many Parents Find Helpful

Good Moms Have Scary Thoughts: A Healing Guide for the Anxious, Depressed, Worried, Overwhelmed New Mom by Karen Kleiman, illustrated by Molly McIntyre (2019), is written for new parents. Kleiman and psychologist Amy Wenzel also wrote Dropping the Baby and Other Scary Thoughts, a more in-depth guide.

When to Get Help Right Away

Seek emergency care (call 911 or go to the emergency room) if you or a loved one:

  • Has thoughts of harming the baby that feel acceptable, justified or like something you might do, rather than upsetting
  • Sees or hears things that aren’t there, or has beliefs others find strange
  • Is confused, can’t sleep for days or seems very different from usual

If you have thoughts of ending your life, call or text 988. You can also call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) to talk through what you’re experiencing, 24 hours a day.

Frequently Asked Questions

Are intrusive thoughts normal after having a baby?

Yes. In a large study, nearly all new mothers had unwanted thoughts of accidental harm to their baby, and more than half had unwanted thoughts of intentional harm.

Does having intrusive thoughts mean I’ll hurt my baby?

No. ACOG says most people who find these thoughts distressing will not act on them, and research found these thoughts were not linked to aggression toward babies.

How long do postpartum intrusive thoughts last?

They tend to be most intense in the first two months and fade or stop by about 6 months for most people. Treatment helps if they persist or cause significant distress.

What is the difference between intrusive thoughts and psychosis?

People with intrusive thoughts know the thoughts are unwanted and don’t make sense. Postpartum psychosis involves losing touch with reality, with little insight into symptoms, and is an emergency.

How do you stop intrusive thoughts after birth?

Trying to push thoughts away often makes them stronger. CBT with exposure and response prevention and, when needed, an SSRI are the most effective treatments.

Can dads have intrusive thoughts about the baby?

Yes. Fathers can experience them too, though there is less research on fathers.

PostpartumDepression.org Team
Written by:

Jenna Carberg was diagnosed with postpartum depression following the birth of her daughter in 2016. It was a healthy birth but in the following days, Jenna's mood changed quickly. Doctors suggested that it might be the "baby blues", but her husband Chris suggested she seek a second opinion. Jenna was diagnosed with postpartum depression and began a journey that lasted 9 long months with significant ups and downs. Jenna's mental health care and her experiences became a passion for her to share with the world. She and her husband Chris founded PostpartumDepression.org as a support website designed to help women suffering in silence and their loved ones.

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