Intrusive Thoughts in Motherhood: What They Mean
Why Your Brain Shows You the Worst Thing
A lot of mothers are frightened of their own thoughts this month. The coverage has given a generation of women a vocabulary for something many of them were already carrying, and it has also handed them a terrible frame for it. Postpartum psychosis is now a phrase almost everyone has heard and yet there still seems to be a lot of confusion about what it truly is. Which means a huge number of women are lying awake tonight running a thought they had this afternoon against a headline, trying to work out whether they are the beginning of a story.
You are standing at the top of the stairs holding her. The thought arrives fully formed, with picture and sound. You could drop her.
You are running the bath and testing the water on your wrist, and something in you says, calmly, like it is reading a weather report: you could hold her under.
You are chopping onions and you look at the knife and then at the baby monitor and you put the knife down and stand very still for a second.
You are driving over the bridge and your hands tighten on the wheel because your brain has offered you, unrequested, a full simulation of the car going over the side with all three car seats in it.
And then you go back to chopping the onions, because the pediatrician appointment is at two and you have not eaten since yesterday.
Here is what almost nobody says out loud at the mom group. In one study, a hundred women were followed from pregnancy through twelve weeks postpartum and interviewed about unwanted thoughts of harm coming to their newborns. Thoughts of accidental harm were universal. Every mother in the sample had them. Close to half of the same group also reported unwanted thoughts of harming the baby on purpose (Fairbrother & Woody, 2008).
Almost none of them say it out loud in the pediatrician's waiting room
What an intrusive thought actually is
An intrusive thought is a thought you did not choose, do not want, and find upsetting. That last part is really important. The distress is the “diagnostic feature.” The thought shows up, you recoil from it, and then you spend the next four hours conducting an internal investigation into what kind of person thinks something like that.
The investigation is the part that hurts. The thought itself lasts a second and a half.
What makes these thoughts feel so dangerous is that we have all absorbed an idea that thoughts are drafts of intentions. That somewhere underneath the thought is a wanting. This is not how the mind works, and it is worth saying plainly: the presence of a thought tells you nothing about what you will do.
That has been measured. In a study following new mothers across the first nine months postpartum, women who reported unwanted thoughts of intentionally harming their infants were no more likely to have behaved aggressively toward their baby than women who reported no such thoughts. The overall rate of any aggressive behavior in the sample was 2.9 percent, and it did not rise with the thoughts (Fairbrother et al., 2022).
Your brain generates enormous quantities of material every day and you experience a small percentage of it. The material that breaks through into awareness is the material tagged as important. And after you have a baby, your brain retags almost everything.
Your threat detection got promoted
Something happens in the postpartum brain that is incredibly useful and extremely exhausting. Your threat detection system gets turned up, because you are now responsible for an organism that cannot regulate its own temperature. So your brain begins scanning, constantly, for what could go wrong.
Scanning for danger means generating danger. That is the mechanism. To check whether the staircase is a hazard, some part of you has to model the fall. To check the bathwater, some part of you has to model the drowning. The image is the check running. It is your brain doing its job with the volume all the way up, in a body that has not slept for more than three hours since March.
Which produces the thing that makes women cry in my office when they finally hear it: the frequency of these thoughts tracks with how closely you are watching. Mothers who are least attached to their infants do not lie awake cataloguing every way the world could take them. The thought you are most ashamed of is running on the same circuit as your love. It is the same system. It is the alarm attached to the thing you would not survive losing.
Where the actual line is
The difference is clear once you know what to look for, and the news coverage will not teach it to you.
Intrusive thoughts are disturbing to the person having them. They feel foreign, wrong, and horrifying. Women having them go to great lengths to prevent harm: handing the baby to someone else on the stairs, avoiding the kitchen, refusing to bathe the baby alone. The behavior is protective, sometimes to the point of exhaustion. The person knows the thought is a thought.
Postpartum psychosis works differently, and one of its cruelties is that it does not feel alarming from the inside. It involves a break from shared reality. Beliefs that are not true but feel completely true and are held with conviction. Hearing or seeing things that are not there. Confusion, disorientation, an inability to track a conversation. Going days without sleep and not feeling tired. Rapid, extreme shifts in mood. Suspicion of people close to you. Often the ideas are religious or grandiose or centered on the baby being in danger, or the baby being something other than a baby.
The distinguishing question is not what the content of the thought is. It is your relationship to the thought. If it frightens you and you know it is not real, you are describing an intrusive thought. If it feels reasonable, true, or like a message, that is a medical emergency and it needs care today.
Postpartum psychosis is rare. It is also treatable, and it moves quickly.
If you are reading this at 3am
If you are having thoughts that scare you and you know they are not real, you can tell someone. A therapist who works with perinatal clients will not be shocked and will most likely tell you that they heard something in the same shape earlier that week. Disclosure is the treatment. It is remarkable how much smaller these thoughts get once they have been said out loud in a room with another person in it.
If any of the following is happening, do not wait for a morning appointment:
The thoughts feel true, or reasonable, or like instructions
You are seeing or hearing things others do not
You have gone more than a day or two without sleep and do not feel tired
You are having thoughts of ending your life
You are afraid you might act
Call the National Maternal Mental Health Hotline at 1-833-852-6262, or the 988 Suicide and Crisis Lifeline by dialing 988. Both are free and staffed 24 hours a day. Postpartum Support International can be reached at 1-800-944-4773. If someone you love is describing beliefs that do not match reality, go with them to an emergency room.
What helps
Treatment for intrusive thoughts is well established and it works. Most of it involves changing what you do with the thought rather than trying to stop the thought, since pushing it away tends to bring it back louder, which any woman who has tried it already knows. That means learning to let the thought arrive, register it as noise from an overactive alarm, and decline the investigation.
The other half is sleep, support, and being told the truth by someone qualified to tell you. A great deal of postpartum suffering is a nervous system being asked to run without maintenance in a culture that treats a mother's exhaustion as the baseline condition rather than the problem.
You are not the beginning of a story. You are a person whose alarm system is working overtime because there is now something in the world you cannot bear to lose.
Frequently Asked Questions
Are intrusive thoughts normal after having a baby?
Yes. Unwanted thoughts about harm coming to an infant are extremely common in new parents, including thoughts of causing harm. Research following new mothers through the first nine months postpartum found no increased risk of aggression toward the infant among women who had these thoughts. Distress about them is the ordinary response.
What is the difference between intrusive thoughts and postpartum psychosis?
Intrusive thoughts feel foreign and frightening and the person knows they are not real. Postpartum psychosis involves a loss of contact with shared reality, where beliefs feel true and are acted on with conviction. Psychosis is a medical emergency requiring same-day care.
Should I tell my therapist about scary thoughts about my baby?
Yes. Perinatal clinicians hear this regularly and disclosure is a core part of treatment. Saying the thought out loud reliably reduces its intensity.
References
Fairbrother, N., & Woody, S. R. (2008). New mothers' thoughts of harm related to the newborn. Archives of Women's Mental Health, 11(3), 221–229. https://doi.org/10.1007/s00737-008-0016-7
Fairbrother, N., Collardeau, F., Woody, S. R., Wolfe, D. A., & Fawcett, J. M. (2022). Postpartum thoughts of infant-related harm and obsessive-compulsive disorder: Relation to maternal physical aggression toward the infant. The Journal of Clinical Psychiatry, 83(2), 21m14006. https://doi.org/10.4088/JCP.21m14006
Overture Therapy supports the woman behind the mother. If you're navigating overstimulation, anxiety, or burnout in motherhood, reaching out is a place to start.
Maya Kruger, MA, LCAT, LPC, RDT, PMH-C, CTT3
Licensed psychotherapist · Founder, Overture Therapy · Maternal mental health specialist