Information on intrusive thoughts for mothers/birthing people navigating the perinatal experience and their providers
By: Sarah Pinson, Ph.D. Perinatal Psychologist at The Motherhood Center
What Are Intrusive Thoughts?
Intrusive thoughts are unwanted, disturbing thoughts that come to your mind more or less randomly. They can be nonsensical, upsetting, or even scary, and may leave you wondering where they came from. In the pregnancy and postpartum period, intrusive thoughts can often involve images of harm coming to the baby (either by you or by someone else), or harm coming to you. Some intrusive thoughts may come to your mind “out of the blue,” while others may be based on a story you heard or a movie you watched.
Intrusive Thoughts in the Perinatal Period
While unpleasant, intrusive thoughts are exceedingly common in the pregnancy and postpartum period. It is estimated that 70 to 80% of mothers and birthing people are affected by them. Intrusive thoughts are understood to result from a combination of factors, including your instinct to be on “high alert” as a new parent, changes affecting the brain in the perinatal period, and hormonal fluctuations. Having a prior diagnosis—especially Anxiety or OCD—is also associated with more frequent intrusive thoughts in the pregnancy and postpartum period.
What Do Intrusive Thoughts Mean?
If you experience intrusive thoughts and are reading this article, you may be wondering what these thoughts mean about you. If the intrusive thoughts involve you harming the baby, you may also be wondering if that means that you are more likely to act on them.
Let’s start with the first question: What do these thoughts mean about you? A better question yet would be—do these thoughts mean anything about you at all?
Thoughts are just thoughts.
Let me state this again: thoughts are just thoughts. Our brains are designed to produce thousands of thoughts daily. Not all of them are relevant or beneficial, and we don’t pause to register or wonder about most of these thoughts.
It is very likely that most humans have intrusive thoughts pop into their minds daily—but they don’t experience them as such because they don’t pause to pay attention or wonder about the meaning of these thoughts. The thoughts pass through, and they may forget they even had them (and then they will tell you that they don’t have intrusive thoughts!).
In other words, the thoughts themselves are not what creates the questioning or distress—it is the act of holding on to the thought and trying to analyze it that gives them power. The discomfort comes from our response to the thought, not the thought itself.
So, what does it mean if you have intrusive thoughts?
It simply means that you have a brain that offers you thoughts, and you notice some of them and wonder or worry about them.
But What About Harm-Related Thoughts?
Understandably, harm-related thoughts may feel especially disturbing. You might wonder: Is this some disavowed ambivalence I have about my situation? Is it something deeper?
Maybe.
Or maybe it’s simply your brain using an evolutionary strategy to keep you vigilant and protect your baby. We can’t have certainty regarding the meaning of any thoughts, and we don’t always have the answers. It is the way you deal with uncertainty that will be important to consider, especially in the perinatal period.
If the lack of certainty makes you analyze your thoughts repeatedly, or if you find yourself avoiding certain activities in your life or with your baby because of them, it may be time to speak with a mental health provider who can help you explore and cope with what you’re experiencing.
Do Intrusive Thoughts Mean I’m More Likely to Act on Them?
This is a crucial concern for both mothers/birthing people and the providers who care for them. The fear that an intrusive thought may predict actual behavior is common, but it is not supported by research or clinical experience.
To address this worry, we must understand the difference between ego-dystonic and ego-syntonic thoughts.
- Ego-dystonic thoughts (like most intrusive thoughts) feel foreign, scary, and inconsistent with your values. The very fact that they cause distress means they’re not aligned with your intentions.
- Ego-syntonic thoughts, by contrast, feel in line with one’s beliefs or goals and may require urgent care.
A mental health professional can help assess these types of thoughts. Research supports the fact that people with dystonic thoughts are unlikely to act on them.
How to cope with intrusive thoughts?
Different techniques exist and here are a couple:
- Cognitive defusion: say the thought in your mind with a funny voice (e.g., a voice from The Simpsons)
- Notice the thought and let it be, neither hold on to it nor push it away: “oh, here is that thought again,” or “I know that thought, it popped in my mind again.”
- Remind yourself “a thought is just a thought” and practice sitting with the uncertainty of the meaning of thoughts
When to Seek Support
If intrusive thoughts are:
- Causing significant distress
- Repeatedly analyzed or obsessed over
- Interfering with life activities or caregiving
- Leading to avoidance behaviors
- …then a consultation with a perinatal mental health specialist can help.
At The Motherhood Center, we provide a spectrum of support—from outpatient therapy to our intensive Day Program—to help mothers and birthing people find relief from intrusive thoughts and other PMAD symptoms. Support groups are also available to connect parents navigating similar experiences.
Final Thoughts
For mothers/birthing people:
You are not your thoughts. And you are not alone.
For providers:
When working with clients navigating intrusive thoughts, validation and normalization are essential. Intrusive thoughts are not inherently pathological—but the distress they cause can be. Gentle inquiry, psychoeducation, and referrals to perinatal-trained clinicians can make all the difference.
If you or someone you care for is struggling with intrusive thoughts during the perinatal period, reach out to The Motherhood Center at 212-335-0034 or visit themotherhoodcenter.com.