When “What If” Thoughts Steal the Joy: Understanding Postpartum OCD

It is one of life’s most joyous moments, holding and meeting your newborn baby for the first time. In that singular moment your life as you knew it before will never the same. You know the extraordinary lengths you would go to protect your child, that this love you feel for that baby is unlike anything you’ve ever felt for anything or anyone before. So why is it that all of a sudden you are consumed with these unwanted and distressing “What if” thoughts that involve harm coming to your baby? Now during the most happiest moment of your life, you are also faced with combatting these terrifying thoughts and feelings surrounding harm coming to your baby. No one can see or hear these fears that are taking you down, but you find the only way to desperately quiet these thoughts are through repetitive actions or mental rituals, also known as compulsions. And so begins a tireless push and pull of combatting these thoughts with compulsions all while they quietly steal what should be happy moments of parenthood. This unfortunate reality is one that can affect any new parent, and it is known as Postpartum OCD (PP-OCD).

What is Postpartum OCD (PP-OCD)?

 PP-OCD is a subtype of OCD that is hugely prevalent, yet not talked about nearly enough, “OCD that occurs immediately after birth is called Postpartum OCD” (International OCD Foundation. (2024). Postpartum and perinatal OCD fact sheet. IOCDF. https://iocdf.org/wp-content/uploads/2014/10/Postpartum-OCD-Fact-Sheet.pdf). PP-OCD is often defined as having intrusive, distressing thoughts- typically obsessional fears centered on the newborn baby- often followed by repetitive or compulsive behaviors directed towards reducing the anxiety (Healthline. (2024, January 3). Postpartum OCD: What You Need to Know. https://www.healthline.com/health/ocd/everything-you-need-to-know-about-postpartum-ocd). In one most recent study, it was found that the prevalence of postpartum OCD ranged from 2.43%-9% among women and 1.7% among men (Ferra, I., Bragança, M., & Moreira, R. (2024). Exploring the clinical features of postpartum obsessive-compulsive disorder — a systematic review. The European Journal of Psychiatry, 38(1), 100232. https://doi.org/10.1016/j.ejpsy.2023.100232). It is important to note that while PP-OCD predominately affects mothers, it can also affect fathers and other providers as well.

What do Postpartum Obsessions and Postpartum Compulsions look like?

Postpartum OCD thoughts can manifest in many different ways, but here are a few examples of what this might look like for someone with PP-OCD:

“What if I drop my baby?”

“What if I accidentally touch them inappropriately during a diaper change?”

“What if I sleepwalk over to my baby’s crib and throw them down the stairs?”

“What if I am bathing my baby and they slip under the water and drown?”

“What if that story I read about that mom who killed her children will happen to me?”

When these distressing thoughts come up, oftentimes someone is left with an overwhelming thoughts of fear and panic which can only be subsided with compulsions. While these compulsions may temporarily subdue these feelings of anxiety, the cycle ultimately continues as the brain learns engaging in a compulsion is the only way to combat the anxiety. Compulsions can also manifest in many different ways, but here are also a few examples of what this might look like for someone with PP-OCD:

Constantly monitoring the baby when they are sleeping

Rechecking doors, cribs, baby monitors over and over

Avoiding being along with the baby due to fear of harming them

Avoiding caregiving tasks despite wanting to do them

Googling symptoms or risks excessively

Asking others if they think you are a bad parent or violent person

Mentally reassuring yourself with thoughts like “I would never hurt my baby”

Whether it is your first time being a parent or not, it is common and also inevitable to experience worry related to your newborns wellbeing. However when the thoughts begin to feel intrusive and consuming, and the behaviors meant to relieve anxiety can take up significant time and mental energy, it might be time to speak to a therapist or doctor. Particularly if your obsessions and compulsions are interfering with your sleep, bonding with your baby, or daily functioning.

Do These Thoughts Mean I Want to Hurt My Baby?

PP-OCD is not only cruel in its invisibility, but in the shame it generates within the person having these intrusive thoughts. This fear of being judged often discourages people from seeing treatment. It is really important to understand that PP-OCD is not in any way a precursor or indicator that an individual will or even wants to commit harm to their child, “Most women with postpartum OCD become extremely upset by their thought process, causing them to be overly anxious about caring for their child. They are typically very attached to their babies and have no desire to act on their bizarre thoughts. Rather, the thoughts become their worst fear (Texas Children’s Hospital. (2025). Could I have postpartum OCD? Texas Children’s Wellness. Retrieved from https://www.texaschildrens.org/content/wellness/could-i-have-postpartum-ocd). While PP-OCD involves intrusive, unwanted thoughts with little to no risk of harm, it is important to distinguish that here from postpartum psychosis which is a rare but serious condition that includes a loss of reality and an elevated risk of harm. Because of this, postpartum psychosis requires immediate medical attention.

Is it Treatable?

There is absolutely hope with treating PP-OCD and research shows Cognitive Behavioral Therapy (CBT)-especially Exposure and Response Prevention (ERP)-is highly effective for treating PP-OCD. ERP helps individuals gradually face feared thoughts or situations while also resisting compulsive behaviors, allowing anxiety to decrease naturally over time. ERP is crucial in re training your brain to become less and less reliant on compulsive behaviors to subdue anxiety. In some cases, a doctor or psychiatrist may discuss medication options alongside therapy if appropriate. With proper treatment and a trained therapist, many parents experience significant relief and are able to feel more confident, present and connected with their newborn during the postpartum period.

Self-Care and Awareness for Postpartum OCD

Bringing awareness to PP-OCD is an important step in recognizing that intrusive thoughts and anxiety are part of a treatable condition-not a reflection of your character or love for your baby. Practicing self-care can help manage stress and support recovery alongside therapy.

Some helpful strategies include:

Mindfulness: Take small moments to notice thoughts and feelings without judgement, which can reduce the intensity of anxiety.

Daily self-care: Prioritize your sleep, nutrition, gentle movement and rest when possible. Remember that you can never pour from an empty cup!

Connecting with others: You do not have to feel alone. Share your experiences with trusted friends and loved ones. Even joining a support group may also be beneficial. Feeling understood can be incredibly grounding.

Setting realistic expectations: Remind yourself that healing both physically and mentally does not happen over night. Be gentle with your journey and reach out for help.

Combining awareness, self-care, and professional support can empower you to manage postpartum OCD and nurture both your well-being and your bond with your baby.

Michelle Clevenger