Postpartum Intrusive Thoughts: Therapy vs Medication | Mind and Motherhood.

In this article, I will discuss what intrusive thoughts are, where they come from, how normal they are, the stigma/shame attached to them, why mothers don't reach out to their GP and if medication, therapy, or both are the answer.

A typical Postpartum Question

Typical Postpartum Intrusive Thoughts

You have everything you've ever wanted in your arms, your sleeping baby breathing softly and you can't believe how you got this lucky. You break your loving gaze and look up to see your partner bringing you a coffee into the lounge, and immediately it happens. "The entire contents of the cup are going to end up on the baby, they'll need skin grafts, they might die, this is horrendous and it's all my fault." But of course, your partner sets the coffee down on a table far away from the baby, smiles at you, and asks how you are. "Fine," you say, with a smile back. Why does this happen? Why do intrusive thoughts plague your daily life after having a newborn and what should you do about them?

What are Postpartum Intrusive Thoughts?

Intrusive thoughts are unwanted thoughts, images, or urges that come from nowhere and are often distressing in nature. From my understanding, these intrusive thoughts come from fear that your baby could be harmed somehow or something terrible could happen to your baby and you are to blame.

Let's take a moment to think about the fear element; after you've had a baby, your brain enters a heightened state of protection. Danger could be anywhere and you're ready for any eventuality, even if the danger is yourself (in your mind). The brain is designed to help keep your baby safe; however, sometimes that design can be overstimulated and overactive and, before you know it, you're experiencing several "what if" thoughts every hour. "What if they stop breathing?". "What if I poison them with formula by mixing it wrong?". "What if my usually placid dog becomes vicious for no reason and bites the baby?". "What if, what if, what if?". The cycle continues day in, day out and it's exhausting. What's even more exhausting is that most mothers feel they can't discuss these thoughts with anyone. That is a very lonely place to be, lonely and very scary.

Let's get logical for a moment and decipher where these intrusive thoughts post birth come from and why they happen in the first place. After having a baby, you go through one of the biggest hormonal shifts of your life. Your mood can crash, anxiety can increase and your emotional regulation goes out of the window. It's like your period on crack, so to speak.

Why Do Intrusive Thoughts Happen After Birth?

You're also terribly sleep-deprived, making your brain more vulnerable to thoughts like these. On top of that, you have this massive responsibility of caring for a vulnerable baby, which would naturally make anyone be heightened to fears and worries. Many mothers have experienced historical trauma in their lives and previous life trauma can make you more sensitive to perceived threats. When you've experienced trauma in your past, intrusive thoughts can be the mind's way of processing fear, vulnerability and loss of control after a traumatic birth or difficult experience. Many women suffer from postpartum anxiety, OCD and depression. These mental illnesses can make intrusive thoughts stronger, more frequent and upsetting.

Let's take the power out of these thoughts now and let me reassure you that intrusive thoughts are different from intentions. If you're horrified by a thought and seek reassurance or it makes you feel distressed, that is more than likely an anxiety response; there's no desire to act on the thought. Many mothers carry these thoughts silently due to the perceived shame attached to them; mothers worry about judgment or that people will think they're not safe to be with their baby.

My Own Intrusive Thought Experiences

Let me share some of my own, as my aim with this website is to help others feel less alone, as well as hopefully being helpful too!

I didn't breastfeed because I was convinced

I would fall asleep and suffocate my baby.

I carried a pair of scissors through the lounge where she was asleep and thought I was going to stab her with them. I wasted 6 bottles of formula in a row because I told myself I'd counted wrongly and I'd poison her to death (I knew I'd counted the right number of scoops). I also wouldn't carry her up or down the stairs until she was 4 months old, as my head told me I would throw her from top to bottom. I hope someone is reading this now and thinking, "Oh my goodness, me too, I'm not alone." I will say it again, sharing these thoughts takes the power out of them. It absolutely does not mean you are a bad mother, an unsafe mother, or that you're losing your mind. However, I wouldn't be responsible or working my way towards being a mental health professional if I didn't caveat what I've just said by saying if these thoughts do become too big, too real and you feel like you might act on them, then you should contact your GP and if you need help immediately, contact your local crisis team or 999.

I didn't reach out to my GP for a long time as I thought I would be thrown into an institution for bad mothers or social services would take Blake, my new born, away from me. When I told my wife about how I was feeling, it was the biggest relief in the world and my GP was also very supportive. I wasn't judged, ridiculed, or chastised for how I was feeling and what I was thinking. I felt free for sharing what I was experiencing, and I implore you to do the same.

How Common Are Postpartum Intrusive Thoughts?

Let's take some more power out of these thoughts, shall we? Research suggests that between 70-100% of new mothers experience unwanted intrusive thoughts about their baby being harmed at some point during the postpartum period. Do you know what that screams to me? That we're not alone, I'm not alone and you, the reader, aren't alone either. I cannot stress this enough, you're a good mother, you're doing a great job, and you love your baby and your baby loves you.

I'm going to touch on whether I think medication or therapy is the better option for intrusive thoughts in new mothers. I can only really give you the wisdom of my experience and everyone is different. I have mentioned this in other blogs, that the mind is so complex and not everyone's experiences are the same, even if their symptoms are. A dose of sertraline, for example, doesn't work like a dose of paracetamol, in as much as, symptomatically, you might present the same as another mother suffering with postpartum intrusive thoughts, but your reaction to sertraline may make your symptoms worse but ease theirs, whereas paracetamol is a 'one drug fits all approach'. Sadly, I think some doctors and psychiatrists play 'Russian Roulette' with mental health medication; they pick one and hope for the best. If that one doesn't work, they try the next one and then they add other medications to counteract the side effects of those medications and the cycle continues.

Therapy vs Medication for Postpartum Intrusive Thoughts

My opinion is, always, always, always, take up the offer of the therapy. The waiting lists are long and the wait feels like an eternity. So, in the meantime, take the offer of the medication too. I found that it eased my thoughts massively, it gave me some mental clarity, some peace and I was able to enjoy my baby guilt-free. However, it also gave me the capacity to share my thoughts when the time for therapy came.

Therapy	Medication
Treats underlying causes	Reduces symptoms
Long term coping skills	Often works faster
No medication side effects	May have side effects
Useful for birth trauma	Helpful for moderate to severe anxiety

I had so much trauma to unpack that I actually felt ready to unpack it when the time for therapy came around. I'd love to discuss this further in the Mind and Motherhood group; let's help each other feel less alone and see what worked for everyone?

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You're Not Alone - Final Thoughts

There are a plethora of therapy options for OCD, depression, anxiety and trauma and it's important to find one that works for you, just like it's important to find the right medication if that's the route you decide to go down. I intend to do another blog on all the different types of therapy for all things postpartum period so that I can hopefully help you make a more informed choice.

Remember, these thoughts are just thoughts, you have no control over them, you don't ask for them, and they're horrendous, I know they are. But, you're an amazing Mum, you're doing all you can.

Stay hopeful,

Rachel

Please note

“This is a personal blog sharing my own experiences. It is not counselling, therapy, medical, or psychological advice.”