Intrusive Thoughts During Pregnancy & Postpartum
Intrusive thoughts can be a distressing experience, yet are very common, especially in the months after giving birth.
Have you ever been driving across a bridge and think “What if I drove my car off the bridge?” or when standing on the top level of a parking garage think “What if I decided to jump off?” Disturbing and unwanted? Yes. Common? Yes. an indicator of what you actually want to do? Very unlikely.
Everyone experiences unwanted, distressing, and intrusive thoughts from time to time, yet during pregnancy and postpartum, these thoughts can feel extremely distressing.
So what are intrusive thoughts exactly?
Intrusive thoughts can be thoughts, images, or urges that are disturbing, sometimes violent, and don’t align with your values, meaning you likely don’t actually want to act on them. They can feel as if they come out of left field, which adds to the shock value and distress, especially during pregnancy and postpartum. While they are distressing, between 70-100% of birthing people and their partners experience intrusive thoughts during pregnancy or postpartum. Additionally, not just the birthing person can experience intrusive thoughts, but also their non-birthing partners.
Ways intrusive thoughts can show up:
Thoughts. (Well duh.) Oftentimes they can be more specific and at times related or unrelated to what you’re experiencing in your life. For instance having thoughts like “My friends hate me and are just pretending to be nice.” or “What if the plane goes down while I’m on it?”.
Images. For most people, these types of intrusive thoughts show up as pictures of something terrible and distressing happening or movie clips running in your mind’s eye. These can be fleeting, yet disturbing.
Urges. These are attention-grabbing thoughts that make you feel like you have to do something, even if you don’t want to. Urges are often accompanied by physical sensations of acting on the thought.
Intrusive thoughts are what we call “ego-dystonic” meaning they don’t align with your set of values and indicate no desire to act on them.
What types of intrusive thoughts show up during pregnancy & postpartum?
While any type of intrusive thought can show up during pregnancy and postpartum, the most common and at times, most distressing, are thoughts of harm coming to you, your baby, or other loved ones. Common themes that I hear from my clients are:
Fear of intentional harm/safety. These may show up while giving the baby a bath, changing their diaper, or holding them.
Fear of accidental harm. Something bad happening to the baby due to neglect or unintentional harm, i.e. The baby will stop breathing if I don’t check.
Contamination/illness-related. Fears that the baby will contract germs or illness through germs, household toxins, negative vibes from others, improper care such as washing bottles.
Perfectionism-based fears. These largely show up as fears of making the “wrong” decision related to baby or not being a good enough parent.
Sexual/taboo thoughts. Keep in mind these are ego-dystonic, so these thoughts are disturbing and not aligned with one’s set of beliefs. They can be sexual in nature, making parents wonder if they inappropriately touched their baby while changing their diaper, or sexual imagery.
Fears of losing control/snapping/having a psychotic episode. This one I see fairly commonly and oftentimes these thoughts include fears around losing control and harming/killing their baby, themselves or having to be admitted to a psychiatric hospital.
Due to the distressing nature of these thoughts, they also often bring shame, guilt, and fear of having their baby taken away if they share them. Please keep in mind that thoughts are just thoughts, no matter how scary they are, and just because you have a thought doesn’t mean you want to act on it.
So if I’m experiencing intrusive thoughts like these, should I be concerned?
Like I stated earlier, intrusive thoughts during pregnancy and postpartum are very common, with between 70-100% of new parents experiencing them within the first year postpartum. They may be fleeting (and still disturbing), however if you’re able to notice them and move on with your day, they likely won’t be an issue for you.
On the other hand, if you start to notice that they are significantly distressing, persistent, and more time is spent engaging in ways to stop or neutralize them, it would be helpful to reach out to a mental health professional with experience working with OCD and perinatal mood and anxiety disorders to assess for the possibility of perinatal Obsessives-Compulsive Disorder. If this is the case, finding a mental health provider who is trained in Exposure and Response Prevention, the gold standard treatment for OCD, will be essential. In some cases an OBGYN or psychiatric provider may prescribe a selective serotonin reupdate inhibitor (SSRI) in conjunction with therapy.
Some helpful tips for navigating intrusive thoughts include:
Notice and label them as intrusive thoughts.
Remember that you are not your thoughts, you can experience them, but they do not determine your worth as a human or parent.
Build acceptance, try not to suppress. You may not like them or want them, but maybe they can just show up from time to time and you don’t have to get them your attention. The more you struggle with them or try to suppress them, the louder and more frequent they will get.
Using non-engagement responses such as “Thanks mind for trying to protect me and my baby” or “I’m choosing not to engage.” or “I don’t need to respond to this thought right now.”
Practice mindfulness. It will be easier to unhook from intrusive thoughts and refocus on the present moment.
Prioritize your self-care. This one always tends to be tough, but trying to protect your sleep as much as possible and ensuring your basic needs are tended to are incredibly important. Lack of sleep and fatigue only tend to make intrusive thoughts more difficult to disengage from.
