Are intrusive thoughts about harming my baby normal?
Unwanted thoughts about harm coming to a new baby are very common, and having them does not mean you want them to happen or that you will act on them. In a large Canadian study of 763 women followed through pregnancy and after birth, Collardeau and colleagues found that 95.8% reported unwanted thoughts of accidental harm to the baby after birth and 53.9% reported unwanted thoughts of intentional harm. The authors describe these thoughts as normative and usually self-resolving, with most fading or disappearing by six months.
Postpartum Support International (PSI) explains that these images are anxious in nature, not a break from reality. They feel shocking because they clash with everything the parent wants for their child. That clash is the key: the thought is unwelcome, and the parent is upset by it.
What these thoughts can look like
Researchers divide them into two kinds. Thoughts of accidental harm are the most common: what if I drop her on the stairs, what if he stops breathing in his sleep, what if I fall asleep while feeding. Thoughts of intentional harm are rarer and far more upsetting: a flash of an image of shaking, throwing or hurting the baby, or an unwanted sexual thought. The second kind is the one parents are most afraid to say out loud.
Many parents respond by trying to make the thoughts stop or to guard against them. That can include:
- Checking the baby's breathing over and over through the night.
- Avoiding bathing the baby, carrying them on stairs, or being near knives.
- Asking a partner again and again whether the baby is all right.
- Washing or sterilizing bottles and clothes repeatedly.
- Refusing to be alone with the baby in case the thought means something.
Do these thoughts mean I might hurt my baby?
The research is reassuring. In a 2022 study of new mothers in British Columbia, Fairbrother and colleagues found that women who had unwanted thoughts of intentionally harming their infant were no more likely to behave aggressively toward the baby than women without such thoughts, and the same was true for women with and without OCD. An earlier study by Fairbrother and Woody in 2008 found little evidence linking these thoughts to aggressive parenting, and noted that they were more likely when parents were under heavy stress and had little support.
This is not to say that harm never happens. It is rare, and when it does, PSI's materials note that it is usually linked to serious mental illness or to a parent who is very alone and unsupported. That is a reason to reach out, not a reason to hide the thoughts.
When intrusive thoughts become postpartum OCD or anxiety
Everyone gets unwanted thoughts. They become a problem when the parent reads them as dangerous (I am a bad person, I am a danger to my baby) and starts spending large parts of the day fighting, checking or avoiding. PSI describes perinatal OCD as repetitive, unwanted, intrusive thoughts (obsessions) together with urges to do certain things over and over (compulsions), often centered on the safety of the baby. Rates are higher in people who had OCD before.
Postpartum anxiety more broadly can look like constant worry, racing thoughts, trouble sleeping even when the baby sleeps, a feeling of dread, and physical symptoms such as dizziness, nausea or panic attacks. PSI notes that it often appears alongside depression, and the CDC reports that about 1 in 8 women with a recent birth report symptoms of postpartum depression. Is it the baby blues or postpartum depression? covers the overlap. If panic is the main feature, panic attacks explained may help.
Both are treatable. PSI and the Perinatal Anxiety Research Lab at the University of British Columbia point to cognitive behavioral therapy, which works on how the thoughts are interpreted and what you do in response to them, as the most effective therapy for OCD, with evidence for its use in pregnancy and after birth. Medication is sometimes used as well; that conversation belongs with a physician or psychiatric prescriber.
How intrusive thoughts differ from postpartum psychosis
This difference matters, because the two are often confused and parents with anxious thoughts sometimes fear they are losing their mind. Postpartum psychosis is rare: PSI puts it at about 1 to 2 in every 1,000 births, usually beginning in the first two weeks.
In psychosis, a person loses touch with reality. NIMH lists delusions (beliefs that are not true), hallucinations (seeing, hearing or smelling things that are not there), mania, paranoia and confusion. The person may not recognize that anything is wrong, and the thoughts may not feel strange or unwanted to them. With anxiety or OCD, by contrast, the parent knows the thought is irrational and is horrified by it.
Postpartum psychosis is a medical emergency. If you or someone you love shows signs of it, call 911 or go to the nearest emergency room, and stay with the parent and the baby until help arrives. If you have thoughts of suicide, or a thought of harm comes with an intent or plan rather than horror, call or text 988 or call 911.
Telling someone, and getting help
Many parents keep these thoughts secret because they fear being judged or having the baby taken away. Clinicians who work with perinatal mental health hear about unwanted harm thoughts often and are trained to tell them apart from risk. Saying the thought out loud to someone who understands it is usually the start of it losing its grip.
Good places to start are your obstetric provider, midwife or primary care doctor; the National Maternal Mental Health Hotline (call or text 1-833-TLC-MAMA, 1-833-852-6262, at any hour); and the Postpartum Support International HelpLine at 1-800-944-4773, which can connect you with a perinatal-trained therapist. The PSI HelpLine is not a crisis line.
Laura Bass, a psychotherapist in Charlotte, works with adults on anxiety and postpartum concerns in individual counseling, and you can ask Laura whether it would help for a partner to join a session. She does not diagnose or prescribe. See the parenting and postpartum guide for related pages, including postpartum depression in fathers and partners.
Common questions
Why do I keep picturing my baby getting hurt?
Researchers think new parents are primed to scan for danger, and a brain on high alert produces vivid what-if images. PSI's materials with the University of British Columbia note that intrusive thoughts are more common under stress and about things we care about most. The more upsetting the thought feels, the more attention it grabs, which can make it repeat. It is common, and it is treatable when it takes over.
Should I tell my doctor about intrusive thoughts?
Yes. It can feel risky, but describing the thought and how much it frightens you helps a provider understand it as anxiety or OCD rather than intent. Perinatal providers hear this often. If you are worried about how it will be received, you can first talk it over anonymously with the National Maternal Mental Health Hotline at 1-833-852-6262 or the PSI HelpLine.
Can fathers and partners have intrusive thoughts too?
Yes. The University of British Columbia lab's materials, shared by PSI, say fathers have these thoughts too, though less often, find them less upsetting on average, and can find them harder to talk about. PSI reports that 5 to 15% of fathers develop an anxiety disorder such as OCD during pregnancy or the first year. The same help applies.
How long do postpartum intrusive thoughts last?
In the Collardeau study, the most intense period was in the first two months after birth, and for most women the thoughts became less frequent or stopped by six months. If they are taking up an hour or more a day, causing a lot of distress, or leading you to avoid caring for your baby, it is worth getting help rather than waiting.