After you have a baby, your thoughts can get…weird. Not only are you worried about tons of things you probably haven’t ever worried about before (ahem, like how much milk is coming out of your body), but you may find yourself having some scary or disturbing thoughts, thoughts that may feel out of your control. These are called intrusive thoughts—and as difficult as they may be to experience, they’re actually incredibly common for postpartum people. 

We chatted with Dr. Aparna Iyer, a perinatal psychiatrist, to learn more about postpartum intrusive thoughts—what they are, what causes them, and when/if you should be worried about experiencing them. 

Major Care: Intrusive thoughts are a common, but sometimes scary part of the postpartum experience. Can you describe what exactly these kinds of thoughts are?

Dr. Iyer: Intrusive thoughts are unwanted and sometimes disturbing thoughts, which can present in any number of ways. They can be characterized by harm occurring to you, your baby or others. Sometimes these thoughts may be further characterized by the mother’s recurrent fears of accidentally or intentionally harming the baby. Either way, these thoughts can pop into our heads suddenly and make us feel frightened and like we have no control over our own thoughts. These thoughts can be downright terrifying, and some moms can feel embarrassed or ashamed of them. Moms can feel so in love with their babies, so these thoughts completely conflict with their positive feelings of loving and wanting to protect their babies. Many women feel extreme amounts of distress around these thoughts and can sometimes even become avoidant of bonding with baby due to them.

Some examples of intrusive thoughts that I often heare are “What if something bad happens to my baby? What if I drop my baby? What if baby stops breathing? What if baby gets sick? What if I accidentally hurt my baby?”

What causes intrusive thoughts at this time of life? Is it something hormonal? Are intrusive thoughts just part of transitioning to parenthood or do they indicate something else?

For some people with pre-existing obsessive compulsive disorder, their usual obsessions may start to be focused primarily on baby and may increase in intrusiveness, severity or frequency. Women with concurrent depressive symptoms are also at increased risk of intrusive thoughts.

However, even mothers with no prior history of mental health conditions or obsessive thoughts could experience intrusive thoughts during and after pregnancy.

We don’t entirely know what causes intrusive thoughts. We do know that pregnancy and early stages of motherhood are often times of stress and anxiety, and large hormonal and physiological shifts may predispose to the intrusive thoughts. I suspect there is some biological predisposition favoring a protective vigilance around the care and wellbeing of baby that can be hardwired in some parents; for some of these parents, this may be exaggerated unfortunately as intrusive anxious thoughts.

What can people expect regarding intrusive thoughts? How common are they? How long do they last?

Perinatal intrusive thoughts are very common. While many sources cite 1-3% of women experiencing them, some sources say up to 50% of moms experience intrusive thoughts at some point postpartum! It’s hard to know exactly what that number is because many women choose not to report them due to a feeling of secrecy around them.

It’s hard to further characterize the frequency or duration of perinatal intrusive thoughts because it is so dependent on the person who is experiencing it. Some women experience them periodically throughout the day, and some women experience clusters of them around certain times that might be more stressful or when they have an increased sense of loss of control or perception of threat. Periods of heightened stress, anxiety or sleeplessness may result in increased severity or frequency of these thoughts.

When should someone become concerned about intrusive thoughts? Is having them connected to or a precursor of developing a perinatal mood or anxiety disorder?

Intrusive thoughts could be indicative of perinatal OCD, which impacts 1% of pregnant women and approximately 3% of postpartum women.

These thoughts could also occur in conjunction with other perinatal mental health conditions, like depression, anxiety and psychosis.

Typically, we recommend that people seek professional treatment (i.e. reaching out to your medical professional, therapist, OBGYN, psychiatrist) if a) your thoughts start to impact your functioning in any way, b) your thoughts result in compulsive (such as ritualistic or rigid behaviors) often to help you cope with these thoughts, c) or if you have thoughts to harm yourself, your baby or anybody else – which is considered a medical emergency and would need an immediate call to 911 or immediate visit to the local emergency room.

However, remember that you are not alone and do not need to feel your case is severe to warrant asking your doctor for his or her opinion. It’s absolutely okay to share your concerns with your doctor about your intrusive thoughts to see if further evaluation or treatment is needed.

What coping strategies can you suggest for a new parent dealing with intrusive thoughts? 

Most importantly, don’t suffer alone! Reach out to others that you trust for support. Speaking to other mothers and reading about this on forums will give you the opportunity to recognize just how common perinatal intrusive thoughts can be.

Many moms assume that they can just ignore the thoughts, but sometimes ignoring it can make the thoughts feel even more intrusive or louder. The most important thing moms can remember is that intrusive thoughts are quite common and are not reflective of your actual desire. Remember that they do not make you a bad mom and you are not your thoughts!

Is there anything else you’d like new parents to know about postpartum intrusive thoughts?

It is important to know that fathers can also experience intrusive thoughts in the perinatal timeframe! We don’t have as much data around these experiences for fathers, but please know that treatment is highly effective for all people for any disturbing intrusive thoughts and emotional health concerns.

Overall, treatment is typically highly and rapidly effective for parents with perinatal emotional concerns and intrusive thoughts. Various forms of counseling, such as Cognitive Behavioral Therapy or Exposure and Response Therapy, can be a time-limited approach to helping manage these thoughts.

While psychotropic medications are not always necessary, please remember that they can be a powerful and effective tool for many mothers. After having a risk-benefit discussion with their providers, some of these mothers even opt to continue breastfeeding while taking psychiatric medications.

Dr. Aparna Iyer is a Dallas-area board-certified concierge psychiatrist focusing on reproductive and holistic emotional wellness. She is a speaker and writer, and she provides consultation on implementation of mental health wellness practices (including maternal mental wellness) in the corporate setting. You can follow her at her social media page here and learn more on her website.

Please note that the above information reflects the opinions of Dr. Aparna Iyer only and not necessarily of any of the institutions with which she is affiliated. This information is not medical advice and does not replace the advice of your own personal physician. For any medical concerns, please contact your personal physician.