Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood
I would stop breathing whenever I let myself think about something horrible happening to my baby. Leukemia. A deadly car accident. SIDS. A kitchen accident. The list goes on. The thoughts would slam into me out of nowhere. One time, I was changing Hudson’s diaper and had a vision of him and Eric being in a lethal head-on collision. I froze. Diaper in mid-air. I was there. Feeling all the feelings I assume I would feel if that — the worst — happened. Then Hudson peed on me, and I snapped out of it. These thoughts didn’t come every day, but they came often enough that I had to build walls. I refused to let my mind go there. And if it tried, I would combat it with heavy-duty distraction.
When the distractions got too exhausting and less effective, I saw a therapist. She helped me find a balance between running from the nightmares and letting them swallow me. She also helped me recognize that feeling like something horrible was about to happen didn’t mean anything was actually going to happen. It was just a false thought triggered by the facts that my newborn was so vulnerable and I was almost entirely responsible for keeping him alive. She offered heaps of techniques, and I tried them all. The ones that worked are in the upcoming “What to do” section. But according to the therapist, what I experienced was pretty mild. Some women get so buried in nightmarish thoughts about their baby they can barely function.
One of the most frightening mental phenomena some new parents experience is thoughts of intentionally or accidentally harming, or even killing, their child — a type of something labeled “intrusive thoughts.” Most report that they don’t actually want to harm their baby but still have vivid thoughts of doing so. These thoughts can really become frightening for a parent when they’re doing something like bathing their baby, driving with them, or partaking in other activities that present obvious risks. It can cause an almost constant state of paranoia, and keeping things under control can take debilitating amounts of energy. For obvious reasons, this is a mental state parents rarely tell anyone about, out of fear their baby will be taken away. But what many don’t realize is that these thoughts are more common than you’d expect. A study published in BMC Psychiatry found that between 70 and 100 percent of new mothers report unwanted intrusive thoughts of infant-related harm, and half of all new mothers have intrusive thoughts about harming their infant on purpose. These thoughts don’t make you a monster, they’re just a sign you’re experiencing a very treatable psychological condition. Any mental health specialist worth their salt will not even think of reporting you, as long as you can honestly acknowledge that you find the intrusive thoughts disturbing.
When these intrusive thoughts become consistent and regularly impact your ability to function, they might be a sign of postpartum obsessive compulsive disorder (OCD). This can manifest as obsessive attempts to suppress the intrusive thoughts, partaking in obsessive rituals that you are convinced will prevent harm from befalling your baby (like constantly praying or checking on them), or avoiding triggering situations like bathing the baby or driving with them. Not surprisingly, OCD has been connected to issues with serotonin regulation and elevated levels of oxytocin — both of which are hormones impacted during pregnancy and the postpartum period. Obsessions with intrusive thoughts can also be triggered by stressful situations and a rapid increase in responsibility, which are both major elements of early parenthood. Because of these factors, some mental health specialists believe slight OCD tendencies might be a normal by-product of the postpartum experience.
The rarest but most serious cause of these violent thoughts is postpartum psychosis. This condition usually consists of an inclination to harm the baby, extreme paranoia, hallucinations and delusions, sleep disturbances, and disorientation. It typically presents within a week of the baby’s birth. Unlike moms with conditions like postpartum OCD, those with postpartum psychosis rarely realize that they shouldn’t be having thoughts of harming their baby — they don’t find the thoughts terrifying or appalling. This is a situation that requires immediate intervention.
What to do
If the thoughts you’re experiencing are limiting your ability to function, get support from a perinatal mental health specialist. They will likely recommend cognitive behavioral therapy, and they might recommend medication. Follow their advice before you try any of the other suggestions listed below, as you deserve the support of a mental health specialist who can take the unique circumstances you’re working with and help you craft a customized treatment plan. They can also help you normalize what you’re experiencing, which can be an immense relief.
With that said, I want to acknowledge that summoning the courage to tell someone about your intrusive thoughts can be one of the most challenging things you ever do. The good news is, a condition like postpartum OCD is no longer seen as a “scarlet letter.” Ongoing research is helping us understand that these conditions are not signs that someone is a dangerous miscreant, but rather they’re symptoms exhibited by a perfectly normal human experiencing a treatable psychological phenomenon. There’s no shame in speaking up and accepting help. And in the most extreme cases, speaking up might save the life of you or your baby. From there, consider the following:
Remember that the thoughts aren’t “real.” One of the only good things about horrific thoughts about your baby is that they’re likely a shocking contrast to your other thoughts. This contrast can make it easier to pinpoint when a thought is intrusive — aka, a thought that is produced not by the real you but by the condition you’re navigating (e.g., OCD, anxiety, or depression). This realization can help you separate from the thoughts and remember that they’re not indications of something you will do, or even want to do, and they aren’t markers of how you feel about your baby.
Write down what’s true. If you start getting lost in all the horrible things that could happen, home in on what’s actually real by writing it down. For example, you might write, “I grew and birthed my baby — that wasn’t easy; it took strength and courage. I provide a home and nourishment for my baby. I’m not broken. These thoughts aren’t me. These thoughts aren’t true. I love my baby. That’s true.” Keep writing until you feel firmly planted in your truth.
Bring yourself back to reality with your five senses. Another way to pull your mind out of a swirl of worst-case what-ifs is asking, “What do I see, smell, taste, hear, and feel?” Keep listing things your senses are experiencing until the intrusive thoughts loosen their grip.
Remind yourself that you’re not crazy. When you have intrusive thoughts you’re experiencing a symptom, just like someone with the flu experiences the symptom of a fever. And just as the flu can strike anyone, intrusive thoughts can strike anyone. So when you have the symptom of intrusive thoughts, continually remind yourself that you’re a whole, amazing person having an uncomfortable experience that will pass with the right support. And as long as you recognize that the thoughts are disturbing and are nothing you should act upon, you’re doing fine, as this is an indicator that you’re not experiencing postpartum psychosis. Of course, these thoughts aren’t fun, and they could be a sign of postpartum OCD, an anxiety disorder, or postpartum depression, so get that support, mama.
Find a support group. In addition to seeking support from a perinatal mental health specialist, it can be helpful to find an in-person or online support group composed of women having similar thoughts. This can help you feel less alone, normalize your experience, and help you develop a deeper understanding of what you’re going through. To ensure you find a quality group, ask your therapist for recommendations.