Intrusive Thoughts 😔

I would like to talk a little about intrusive thoughts in the postnatal period.

Intrusive thoughts are made up of unwanted and distressing thoughts and images, that are hard to dismiss and that tend to recur.

They can be incredibly distressing….and are often not disclosed to HCPs, friends, partners or family out of shame, fear of social services and general taboo around the subject.

The thoughts are often about causing harm to the baby (throwing them down the stairs, letting the pram roll into traffic, etc etc) and are usually totally at odds with the general nature of the person having them.

But what if I told you that approximately half, HALF of all new parents/mothers report having intrusive thoughts.

They are INCREDIBLY common. They are NOT an indication that the person is more likely to harm their baby than a person who is NOT having intrusive thoughts. They are NOT shameful.

They CAN be associated with postnatal depression, anxiety or OCD, but they may not be and exist in isolation.

Talking about the intrusive thoughts may make them less likely, and NOT talking about them may make them recur more frequently.

We really need to talk about this issue more, and break the taboo to help free tired and exhausted brains from them as much as possible, and put support in place if they become overwhelming or in fact ARE a bothersome symptom of postnatal ill health.

There are questions HCPs can ask the person experiencing such thoughts:

Is the person indifferent to the intrusive thoughts?

Is the person emotionally unaffected by the thoughts?

Does the person try to trigger the thoughts?

Does the person decline help to manage the thoughts?

Does the person intend to act out the thoughts?

Has the person ever intentionally harmed her baby?

Generally, a negative answer to those questions indicates a VERY low risk of a person actually carrying out the thoughts…..but even if the first few answers are affirmative, it does not mean harm will occur. A holistic assessment is appropriate, and of course the initial exploration of this issue is always easier in a relationship based, continuity models of midwifery, where mutual trust and openness are already a feature.

I have chatted about intrusive thoughts with many many clients over the years, and for most of them, they were a feature of tiredness, overwhelm, but also occasionally some low mood, depression and anxiety.

Oftentimes, it’s easier to deal with these thoughts if you can acknowledge them (oh, hello intrusive thoughts), rationalise them (no, I don’t wish to actually do this), and dismiss them (ok, I have acknowledged the thought, I shall try to carry on with what I was doing), as resistance to the thoughts is often entirely unhelpful and more distressing.

Of course occasionally, referal to more in depth help and assessment is helpful and appropriate, but to some extent we need to ‘normalise/de-stigmatise’ the phenomenon so that we CAN talk about it.

Silence is not always golden.

ETA: it’s also worth mentioning that *worrying something bad will happen to the baby* is not what intrusive thoughts are as such…..it’s anxiety. Intrusive thoughts are literally intense thoughts of harming the baby, things most people would never do, but that pop up in your mind in an intrusive and graphic fashion. ‘What if I put that pillow over their head now and squeezed?’ ‘WhT if I threw them out of the window?’ ‘What if I smacked them violently while winding them?’ rather than ‘I have a LOT of worry that they might become sick!’