Frightening intrusive thoughts about your baby: could it be perinatal OCD?
A thought suddenly appears: What if I dropped my baby? What if I lost control and hurt them? What if something I touched, ate or did caused them harm?
The thought feels horrifying. You may immediately begin checking what it means about you. You might avoid being alone with your baby, hide certain objects, clean excessively, repeatedly ask for reassurance or mentally review whether you could be dangerous.
If this is happening to you, you may feel frightened or ashamed. You may also worry that telling somebody will lead them to misunderstand you.
However, unwanted intrusive thoughts are not the same as intentions. When they form part of obsessive-compulsive disorder, they are upsetting precisely because they conflict with the person’s values and desire to protect their baby.
What is perinatal OCD?
Perinatal OCD is obsessive-compulsive disorder that develops or becomes more difficult during pregnancy or following the birth of a baby. Someone who already experiences OCD may find that its focus shifts towards pregnancy, birth or responsibility for their baby.
Research estimates vary, partly because people are often understandably reluctant to disclose their thoughts. One prospective study estimated an average OCD prevalence of 2.9% during pregnancy and 7% following birth, suggesting that perinatal OCD may be more common than was previously recognised.
Perinatal OCD may include fears concerning:
Accidentally or deliberately harming the baby
Contamination, illness or infection
Making the wrong decision during pregnancy
Eating something that could harm the baby
Sudden infant death syndrome or suffocation
Sexual or religious intrusive thoughts
Making a serious mistake in caring for the baby
Needing things to feel completely right, ordered or certain
OCD can also focus on subjects that appear unrelated to the baby. What makes it OCD is not the particular subject of the thought, but the cycle of obsession, anxiety and compulsion that develops around it.
When does an intrusive thought become an OCD problem?
Many people experience odd, upsetting or unwanted thoughts. A thought can appear simply because the brain is continually generating possibilities and scanning for danger.
In OCD, the person attaches particular significance to the thought:
Why did I think that? What if it means I secretly want it? What if ignoring it makes me irresponsible? How can I be completely certain that nothing bad will happen?
This interpretation produces anxiety, guilt or shame. Understandably, the person tries to feel safe again by checking, avoiding, washing, seeking reassurance, researching or mentally reviewing the thought.
These actions may bring temporary relief. Unfortunately, they also teach the brain that the thought was important and dangerous. The next time it appears, the urge to respond becomes even stronger.
OCD asks for complete certainty. Parenthood cannot provide complete certainty, so the search for reassurance can gradually take over more and more of everyday life.
Compulsions are not always obvious
Some compulsions are visible, such as repeated washing, checking the baby’s breathing or avoiding knives. Others happen internally and may be harder to recognise.
These can include:
Repeatedly reviewing your memories
Checking whether you feel like a “good” parent
Trying to replace a frightening thought with a safe thought
Praying specifically to neutralise a thought
Testing whether you could lose control
Comparing yourself with other parents
Asking your partner to check instead of checking yourself
Repeatedly searching online for certainty
Partners and relatives can also become drawn into the OCD cycle by providing repeated reassurance or completing checks. Therapy can help families understand how to offer support without unintentionally strengthening OCD.
Does having an intrusive thought mean I might act on it?
Intrusive thoughts characteristic of OCD are unwanted, distressing and inconsistent with what the person wants. The presence of such a thought is not evidence of an intention to act.
Research examining unwanted thoughts of infant harm has not found that mothers experiencing these thoughts are more likely to harm their babies. Nevertheless, a thoughtful clinical assessment is important because not every mental health presentation is OCD.
Postpartum psychosis is a different and uncommon condition involving symptoms such as hallucinations, delusional beliefs, significant confusion or a marked loss of contact with reality. It requires urgent medical treatment.
If you feel that you may act on a thought, cannot keep yourself or your baby safe, hear voices giving you instructions, or hold frightening beliefs that feel true rather than unwanted, seek urgent help. Contact your GP, midwife, health visitor or NHS 111. Call 999 or attend A&E if there is an immediate danger.
How is perinatal OCD treated?
The main psychological treatment for OCD is cognitive behavioural therapy with Exposure and Response Prevention, usually shortened to CBT with ERP. It is recommended by the NHS and NICE for treating OCD.
ERP does not mean being pushed into your worst fear or being expected to do something unsafe. Treatment should be collaborative and gradual.
Together, we identify the situations, thoughts and feelings that trigger anxiety, as well as the compulsions and safety behaviours that keep the problem going. We then plan manageable opportunities to face uncertainty without completing the usual compulsion.
For example, treatment might involve gradually reducing checking, touching an everyday object without unnecessary washing, spending time with the baby without asking for reassurance, or allowing an intrusive thought to be present without trying to neutralise it.
Imaginal exposure can also be helpful when the feared scenario cannot or should not be recreated in real life. This may involve writing or listening to a carefully planned narrative while learning that thoughts and anxiety can be tolerated without performing compulsions.
Therapy may also draw on psychoeducation, compassionate approaches, attention training and cognitive techniques such as Theory A and Theory B. However, these approaches support rather than replace the behavioural work at the centre of effective OCD treatment.
A free Theory A and Theory B worksheet
I have created a free worksheet to help you examine two different explanations for what is happening:
Theory A: The explanation presented by OCD—for example, “I am having this thought because I am dangerous, so I must prevent harm and achieve complete certainty.”
Theory B: An alternative explanation—for example, “I am having unwanted thoughts because I am anxious and experiencing OCD. My attempts to gain certainty may be keeping the problem going.”
The worksheet helps you consider the evidence for each explanation, the actions each theory encourages and the longer-term effect of living according to it.
You can find the worksheet here, and further information and examples on my Perinatal OCD therapy page.
Specialist perinatal OCD therapy in Leeds and online
My experience includes more than 10 years of working with OCD in NHS Talking Therapies services, alongside specialist training and for last 4 years work with perinatal OCD.
I offer CBT and ERP therapy online and face-to-face in Leeds. Treatment is adapted to your circumstances, particularly when you are pregnant, caring for a new baby or feeling overwhelmed by extensive worksheets and homework.
If you are considering therapy but are unsure where to begin, you can book a free, no-obligation 15-minute telephone consultation through my website. This gives you an opportunity to ask questions and consider whether I may be the right therapist for you.
