Hello again! This is a requested follow-up to my post about SIDS, but this time we will be looking at postpartum anxiety (PPA) and intrusive thoughts.
DISCLAIMER: This post is not a substitute for any form of healthcare. While I will share some “educated tips” I by no means want to give the impression that anything in this post is a cure for PPA or intrusive thoughts.
PPA
A reasonable amount of anxiety is to be expected for new parents. Anxiety is not an enemy. It’s essentially our brain’s threat detection function. Anxiety sounds alarms prior to something unsafe happening, which is why anxiety often presents as, “what ifs…”
For new parents, this can look like:
What if my baby gets sick?
What if my baby isn’t eating enough?
What if my baby goes through sleep regression?
Anxiety wants us to explore and answer these questions in advance. So it will ask the question, wait for an answer, and then scamper off for a while and let you return to your baseline. We’ll put a pin in this for now.
Anxiety becomes “disordered” when it becomes your baseline. You spend more time than not worrying, and the worry is accompanied by physical symptoms of some kind. High heart rate, sweating, muscle tension, digestive issues, etc. Another threshold for disordered anxiety is its controllability i.e. you can’t focus on other things, or it doesn’t respond to rational thinking and the same what ifs continue to return over and over again, or the what ifs become more and more unlikely but feel very likely.
What if the Canadian wildfires reach me and my baby… in Florida?
What if our house collapses for no reason?
What if someone tampered with this unopened, sealed can of formula?
By the way, anxiety absolutely contributes to physical exhaustion, and new parents don’t need MORE of that. If you are experiencing this level of distress, talk to your doctor or pediatrician. You deserve to have a sound mind, you deserve to focus on your baby instead of irrational worries. You deserve to feel good. Needing a little help with that via talk therapy or medication is perfectly okay.
TLDR; Occasional controllable “what ifs” are normal, distress is not. If your worries are adding to your stress, it’s time to talk to your doctor.
INTRUSIVE THOUGHTS
Anxiety asks “what if…” whereas intrusive thoughts regenerate those what ifs as extremely distressing images, words, or what feel like urges. Instead of just asking “what if the Canadian wildfires reach me and my baby” you IMAGINE your baby surrounded by fire. Instead of asking “what if my baby slips from my arms while bathing” you imagine your baby going under the water and staying there.
Anxiety isn’t always distressing. Intrusive thoughts always are… but that’s actually by design, and it has a name: Ego-dystonic.
Ego-dystonic means that these thoughts go against your values and character.
If you feel so inclined, take a deep breath and read that sentence again. This is one of the reasons we feel like we’re going crazy when we have these thoughts, and that feeling is heavy and scary, but remember, it is just a feeling, and feelings are not facts.
Now, occasionally you will hear of something called postpartum psychosis. Postpartum psychosis is completely different from postpartum anxiety or OCD. It involves a loss of touch with reality, such as delusions, hallucinations, or severe confusion, and requires immediate emergency medical care. Thankfully, it is very rare.
So… if ego-dystonic thoughts are against our values and make us feel crazy… why do we have them? This is simply your maternal brain in overdrive. It’s simulating the worst of the worst situations in an attempt to help you prepare for them. Even though these thoughts usually don’t end with us saving our baby from the fire, or pulling our baby out of the water (referring back to the past examples), or stopping ourselves from intentionally dropping or throwing the baby, these thoughts are like a mental dress rehearsal for a play that won’t be performed.
The intrusive thoughts are saying, “Look at this terrible thing. Now, how are you going to make sure it won’t happen?”
You may notice yourself becoming highly emotional after these ego-dystonic thoughts. You may temporarily hold your baby tighter while you walk, you may get the urge to test your smoke detector, and you may take extra precautions during bath time. You may not even notice the connection between the thoughts and these behaviors.
Another side note, if the intrusive thoughts become very frequent and result in repeated behaviors, like checking the smoke detectors, frequently checking to see if baby is breathing at night and feeling unable to stop, or refusing to bathe baby because of what the intrusive thoughts showed you, you may be experiencing postpartum OCD, which is common and treatable. If the intrusive thoughts are commonly about you causing harm to your baby, that can sometimes be referred to as Harm OCD. Yes, it has a name, and that means you’re not alone in it.
Now, what can we do about it? Again, this is where I will offer some tips, but they should not replace talking to your pediatrician and seeking therapy. These tips will not make the anxiety or thoughts go away alone, but they may possibly help you feel better in the moment and turn down the volume on some of the alarms.
(1) Don’t try to force the thoughts or feelings of anxiety out. Simply acknowledge them. “Oh, I’m having a really distressing intrusive thought” or “Hmm… there go those what-if questions popping up again.”
(2) Declare what’s happening in the here and now. “Right now, my baby is safely sleeping in my arms, not being dropped.” “Our house isn’t on fire right now.” “My baby isn’t even near any water… by the way is it time for me to hydrate?”
(3) Think of what you can practically, reasonably control in the scenarios. “When I give the baby his next bath, I can control how slowly and carefully I maneuver him.” “I can make sure I have a good hold on the baby before I stand up and walk with her.” “I can grab the baby and head toward the closest exit if there is a fire.” “If the thought of baby drowning scares me, I can look up local swim lessons to enroll them in when they’re old enough.” On that same note, remember what we pinned further up? Sometimes it helps to actually ANSWER the reasonable what-if questions.
What if my baby gets sick? Then I can check their temperature, monitor them, and schedule a doctor appointment.
What if my baby isn’t eating enough? I can talk to our pediatrician about ways to increase calories if necessary.
What about sleep regression? My partner and I can talk about how we can tackle it in shifts, or I can see if a friend or relative is willing to help us for a day or two.
(4) Use your senses to ground yourself. What are 5 things you can see in that moment? Maybe your baby sleeping peacefully, or the sunshine outside, or the pattern/graphics on your baby’s clothing. What are 4 things you can hear? Your baby cooing, yourself breathing, the AC running, etc. What are 3 things you can feel? The added weight of your baby in your arm, your feet on the floor, the warmth of the bath water you’re running. What are two things you can smell? Your baby’s breath? The lingering smell of the coffee you didn’t finish? And what is one positive thing you can declare about yourself? “I am a present and attentive parent.”
Everyone experiences anxiety to some degree. Per the CDC, postpartum anxiety impacts 1 in 4 mothers, though we also have to account for cases that aren’t reported, so the number could be higher. And roughly 95% of mothers will experience some level of intrusive thoughts.
In other words: You are FAR from alone, and you are FAR from crazy. It feels awful, sure, but experiencing these things means your brain is operating as it should, but if it becomes distressing/disordered, it may be doing it a little too well.
Look at you, overachiever. 😉
Reach out to your doctor or pediatrician if you feel like you need support. You don’t have to push through any degree of distress without help.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6429780/
https://www.americashealthrankings.org/explore/measures/postpartum_anxiety
International OCD Foundation Perinatal Guide