Intrusive Thoughts and Postpartum Depression: What’s Normal and When to Get Help

You’re carrying your baby down the stairs when an image suddenly flashes through your mind: You trip and drop her. Or you’re pushing the stroller across the street and picture a car hitting you both. These thoughts can feel alarming for new parents, especially because they seem to pop up out of nowhere.

Understanding why intrusive thoughts happen — and what separates a common postpartum experience from more serious symptoms that deserve treatment — can help take away some of their power.

What Are Intrusive Thoughts, and Why Do They Happen in Postpartum Depression?

“When we talk about intrusive thoughts, what we mean is these thoughts just pop into our head all of a sudden, and we’re like, ‘Whoa, where did that come from?’” says Milicent Fugate, MD, a reproductive psychiatrist and the director of the day program at the Motherhood Center in New York City, where she specializes in treating people who are pregnant, postpartum, or trying to become pregnant.

“The thing I like to remind people about intrusive thoughts is that they’re actually very common in the postpartum period,” says Laudy Burgos, LCSW, a licensed clinical social worker, board member of Postpartum Support International, and the associate director of social work in the women’s and children’s division at Mount Sinai Hospital in New York City.

• Your baby falls down the stairs.
• A car hits you and your baby while you’re crossing the street.
• The baby flies out of their car seat.
• The baby falls off the changing table.
• You get so upset you shake the baby.
• You smother, suffocate, or drown the baby.
• You sexually harm the baby.

Sometimes, it’s a matter of your brain working in overdrive, scanning for potential danger, such as when you’re carrying your newborn downstairs, handling sharp objects around your baby, or crossing the street with your stroller, Dr. Fugate says.

“The brain is trying to protect something that feels incredibly precious and vulnerable. You’re going through hormonal changes, and a lack of sleep could really make your anxiety and your emotional reactivity more intense, but you’re also changing your role. It’s almost like having that animal instinct that’s there to protect,” Burgos says. “And sometimes that protective system becomes overly sensitive … your brain becomes especially alert to potential threats or harm.”

Intrusive Thoughts and Postpartum Depression: What’s Normal?

There isn’t a specific number of intrusive thoughts per day, or a limit on the number of days they can occur, that separates a typical postpartum experience from a mental health diagnosis.

Instead clinicians look at factors, such as how persistent the thoughts are, how much distress they cause, whether you can move on from them, and whether they interfere with everyday activities, Fugate says.

“What we can see with what we call perinatal mood and anxiety disorders is that sometimes these thoughts can be quite sticky, and they won’t go away,” Fugate says. “While some moms see these thoughts pop in and pop out, for other moms, these thoughts pop in and they stick like glue.”

What becomes more concerning is when the thoughts no longer feel unwanted or at odds with what you believe. Burgos says mental health professionals pay close attention when a parent begins to believe harmful thoughts are sensible. “If now they’re saying, ‘I feel like I may act on it,’ or ‘I feel that God is telling me that I need to do this …,’ then I get really concerned,” she says.

“If the thoughts won’t go away, and they’re impacting your ability to be with your baby, that’s really a sign this is something that we need to talk about,” she says.

Intrusive Thoughts and Postpartum Depression: When to Get Help

You don’t need to wait until intrusive thoughts become unbearable before mentioning them to your obstetrician-gynecologist, primary care doctor, therapist, psychiatrist, or another healthcare professional. If they’re upsetting you, discussing them with a healthcare professional can provide reassurance and help determine whether PPD or another condition like PPA or PPOCD is making them more difficult to manage, Burgos says.

Fugate says one of the biggest barriers to getting support in understanding whether intrusive thoughts are normal is stigma and fear of what the thoughts could mean. “So many mothers struggle with these thoughts in silence.”

Consider reaching out for help if:

• The thoughts feel as though they won’t go away. An intrusive thought that briefly appears and passes is different from a thought that follows you for hours or repeatedly consumes your attention, Burgos says.
• They interfere with everyday life. If intrusive thoughts make it difficult to sleep, eat, work, leave home, care for yourself, or complete ordinary tasks, they’re affecting your functioning and deserve professional attention.

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• You begin avoiding your baby or certain caregiving activities. As mentioned, some parents may be frightened by intrusive thoughts, avoiding diaper changes, bath time or being alone with their baby out of fear of harming them.

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• You’re engaging in a loop of repetitive behaviors to manage the anxiety. Constantly checking that your baby is breathing, repeatedly seeking reassurance, excessive cleaning and washing hands, or other rituals in response to intrusive thoughts may suggest postpartum OCD, rather than typical new-parent worries.

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• The thoughts are causing emotional stress. Lingering intrusive thoughts can bring up feelings of fear and shame for new parents, including those already grappling with depression or anxiety, Fugate says. Research has linked postpartum intrusive thoughts with higher levels of depression, anxiety, and stress — and suggests they may be more severe and distressing in people who already have mental health difficulties.

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• You feel that you may act on a thought. An unwanted, frightening thought is different from wanting to hurt yourself or your baby, believing you should do so, making a plan, or feeling unable to control your actions, Burgos says. If you feel that you want to or may act on thoughts of harming yourself or your baby, that requires prompt professional assessment, she says.

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• You’re having suicidal thoughts. Burgos says that suicidal ideation isn’t necessarily another intrusive thought associated with caring for a baby. “If someone is telling me that they want to harm themselves, that’s different,” she says. “That’s a psychiatric emergency.” If you have thoughts of hurting yourself or your baby, seek urgent medical help.

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• You’re experiencing hallucinations, delusions, severe confusion, paranoia, or loss of touch with reality. These can be symptoms of postpartum psychosis, a rare but serious psychiatric emergency that requires immediate treatment.

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If you’re unsure where your thoughts fall on the spectrum, you don’t have to figure it out by yourself. “Seeking help can be the best thing that you can do for yourself and your baby, as your healthcare provider can help you work through what the risk is with these thoughts,” Fugate says.