“Do You Think I’m Crazy?” What Postpartum Intrusive Thoughts Really Mean

Susie Cobb remembers the first time she carried her newborn son down the stairs. She was still healing from giving birth and unsteady on her feet, so she held the banister in one hand and her tiny child with the other. Suddenly, an image flashed in her mind of the then-35-year-old mom dropping her fragile infant, his skull hitting the tile floor below.

“A feeling of dread and panic washed over me, and I sat down on the stairs immediately,” she says. “I called for my mother-in-law, who came to take him from me so I could climb the stairs back up to my room and return to the bed.”

At first, Cobb, a licensed mental health counselor in Los Angeles, thought the incident was a sign that she needed more time to recover. Still, the terrifying thoughts continued even after she gained more confidence in her physicality. Beyondx the stairs, Cobb pictured catastrophically dropping her baby while changing his diaper or taking him out of the crib. When she carried her son onto her balcony, she pictured throwing him over the edge.

Cobb remembers being flooded with anxiety each time one of these alarming, confusing images would pop up. She was horrified by her own mind; her heart would race as she held her baby tightly, staying away from anything that appeared even remotely threatening. Nevertheless, the mental images didn’t stop, and they cut through her consciousness “like a knife,” she says.

What Are Postpartum Intrusive Thoughts?

Cobb was experiencing intrusive thoughts, or “an unwanted, distressing thought or image that involuntarily pops into your mind,” says Alexa Bonacquisti, Ph.D., PMH-C, licensed psychologist with expertise in reproductive health psychology, certified perinatal mental health specialist, and associate professor of clinical psychology at the Philadelphia College of Osteopathic Medicine.

More specifically, postpartum intrusive thoughts tend to focus on causing harm to the baby, accidentally or intentionally, explains Bonacquisti. You’re walking down the sidewalk when you suddenly think about pushing your baby’s stroller into oncoming traffic. Or, like Cobb, you’re holding your baby somewhere high and are suddenly overwhelmed at the thought of dropping them.

To be clear: Postpartum intrusive thoughts are different from regular worries, at one end of the parental stress spectrum, and more extreme delusions, on the other end. “Worries tend to be future-oriented, voluntary, and involve a more drawn-out cognitive process as compared to intrusive thoughts which suddenly appear, are involuntary, and involve more upsetting or disturbing themes,” says Bonacquisti. And unlike delusions, people experiencing intrusive thoughts recognize them as being false, bizarre, illogical, or wrong.

New parents are especially susceptible to intrusive thinking. In a 2025 study of 349 people who’d had a baby within the last year, more than 96% reported having at least one intrusive thought during the participation period, with 94% saying they experienced intrusive thoughts every day.

Despite being widespread, postpartum intrusive thoughts often go unreported. New parents may feel ashamed or be afraid of being judged or even punished, making them less likely to share their experience, per the Journal of Reproductive and Infant Psychology.

Parents experiencing intrusive thoughts often worry that they’re crazy, says Dr. Lethenia Baker, M.D., Georgia-based OB/GYN, vice chair of obstetrics/gynecology and pediatrics at Wellstar Health System. But questioning these intrusive thoughts in the first place is actually a healthy sign, as it shows you’re in touch with reality, she explains.

When Cobb’s symptoms progressed from thoughts of accidentally dropping her newborn to intentionally harming him, “I started to feel the pangs of shame that something was wrong with me,” she says.

But postpartum intrusive thoughts aren’t a window into some hidden desire in your psyche, says Olivia Verhulst, LMHC, PMH-C, New York-based licensed psychotherapist, adjunct professor at New York University, and certified perinatal mental health provider. “These thoughts do not signify intention,” she says. “In fact, the reason they feel scary for people is because of a certain level of awareness that these thoughts do not align with their values, morals, or intentions.”

Why Postpartum Intrusive Thoughts Happen

There are several reasons the postpartum period makes you vulnerable to intrusive thoughts. For one, you’re experiencing some of the most dramatic hormone swings of your life, says Baker. After childbirth, your levels of estrogen and progesterone plummet, a drop that can affect the areas of the brain that impact emotional regulation.

You’re also dealing with stressors nearly all new moms face — navigating feedings, sleep deprivation, and recovery from childbirth. Combined, this can make you more susceptible to intrusive thinking. “Postpartum is a vulnerable time period with a lot of newness and uncertainty, so a certain degree of anxiety around protecting your newborn would be natural and contribute to increased threat activation in the brain — and consequently, some anxious intrusive thoughts,” says Verhulst.

While upsetting, intrusive thoughts can be considered “normal” in postpartum, says Bonacquisti. “Intrusive thoughts do not always occur in the context of psychological disorders,” such as postpartum depression (PPD) or postpartum anxiety (PPA), she says.

That said, the severity and frequency of intrusive thinking should be looked at in the broader context of symptoms when a doctor evaluates a parent for a perinatal psychiatric diagnosis, she says. For example, persistent, unwanted intrusive thoughts are considered a hallmark symptom of obsessive-compulsive disorder (OCD). In postpartum OCD (PP-OCD), these thoughts often center around harm to your child, per the Journal of Reproductive and Infant Psychology. Obsessive thinking may be coupled with compulsions, or behaviors that are meant to soothe anxiety (such as excessively checking to make sure the balcony door is locked or only scooting down the stairs on your butt).

Intrusive thoughts can occur with PPD, as well. “Postpartum depression can drive and amplify intrusive thoughts,” says Baker. “People with PPD can have feelings of worthlessness and guilt, and can ruminate on certain thoughts, particularly things they feel they’re failing at.”

While intrusive thoughts are present in some perinatal mental health disorders, it’s a persistent misconception that they are a sign of postpartum psychosis, a rare, acute, and severe mental illness that leads to a break with reality shortly after childbirth, says Bonacquisti. “Intrusive thoughts are very different from psychosis because intrusive thoughts are recognized as bizarre and distressing,” she says. “People have insight and awareness that their thoughts don't reflect reality.” Parents experiencing psychosis have fixed beliefs that are not rooted in reality, which leads to confusion, hallucinations, and delusions, rather than intrusive thoughts, she explains.

How to Break Free from Postpartum Intrusive Thoughts

In many cases, postpartum intrusive thoughts resolve on their own, becoming less frequent over time without treatment, says Verhulst. But it’s almost always a good idea to mention them to your doctor, says Bonacquisti. They can help determine any next steps or monitoring, if necessary.

If you need another push to speak up, Baker says there are red flags you should mention to a healthcare provider as soon as possible.

• If intrusive thoughts persist or get worse over time instead of better
• If they replay in your head excessively to the point you can’t fall or stay asleep
• If they lead you to modify your life in some way (avoiding entire rooms or activities)
• If you also experience irritability, feelings of worthlessness, or thoughts of self-harm or harming the baby

It’s also a good idea to let trusted family or friends know what you’ve been going through, so they can offer support, says Bonacquisti.

A Future Beyond Intrusive Thoughts

Cobb recognized early on that her symptoms were distressing enough to warrant professional help, and she experienced a huge shift in her mental health by the time her son was three months old.

The experience with postpartum intrusive thoughts encouraged Cobb to pursue her perinatal mental health certification and eventually open her own practice, Therapy For Mamas, in early 2022. Now, nearly five years later, what she says helped her the most was the realization that the intrusive thoughts weren’t signs that she was a danger to her son. Instead, they were her brain’s safety system alerting her to the possibility of danger.

“It’s like your mind is saying, ‘Be careful; if this happens, it will be bad,’” explains Cobb. “Once I understood that my brain was trying to help me keep him safe, it became a lot easier to decrease my anxiety and depression-like symptoms resulting from these thoughts.”

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