If this is your first time here, hi! I'm Alex. I'm a perinatal mental health nurse, CBT therapist and doula. If you've been here before and read my earlier blogs you'll know they've been more reflective and personal, thinking out loud about birth, its reverence and what it means to prepare for and welcome becoming a mother.
But I've been feeling a pull to use this virtual space in a more useful way too. Most of my working week is spent with women who are carrying things they think they're the only ones carrying, and a lot of it comes with shame. So alongside the reflective pieces, I want to write more regularly with real, practical information that helps and normalises what so many go through. Some blogs will give something to think and reflect on, and others something you can use. I hope both will soften the distance that can feel so wide between us, between you and the other mothers out there, and bring a greater sense of connection through experiences I believe so many of us share.
This one is the second kind, and it’s where I want to start: intrusive thoughts. They’re a phenomenon quietly experienced but so significantly felt. The weight of their impact on a mother’s sense of herself, and on her confidence in mothering, is enormous. And the isolation that comes from something experienced by far more women that we realise makes this an important topic to begin with.
If you've had a thought about harm coming to your baby, even harm caused by you, and it left you frightened, you are not alone. Perinatal intrusive thoughts are one of the most common experiences I see in my work in NHS perinatal mental health, and one of the least talked about, because of the shame they often bring.
What is an intrusive thought?
An intrusive thought is an unwanted thought that causes distress and disturbance. In clinical language we call these thoughts "ego-dystonic", which means they feel completely at odds with who you are and what you want.
Why intrusive thoughts are so common in the perinatal period
Becoming a mother switches on a powerful survival drive. You are biologically wired to keep your baby safe, and to keep yourself safe so that you can keep them alive. That drive naturally brings some anxiety, because anxiety is what we feel when there's a chance of harm.
And when there's a chance of harm, we problem-solve. Thankfully we have a developed prefrontal cortex that plans, organises and prepares. But that is also where worry takes hold: we rehearse the worst case scenario to protect ourselves and our babies from an unlikely possibility.
I write this from a UK perspective, where most of us are housed, fed and have clean water. Even so, the instinct for survival in a new mother is primal, it’s wired-in so deep, it doesn’t assume that basic needs are met, or that they always will be. This is an unconscious process, happening below the surface.
We’re all wired differently. Some of us feel the weight of anxiety more, or find it harder to sit with the uncertainty it brings. Our stress bucket may simply be smaller. The reasons are many. It might be genetics or temperament. It might be the environment we grew up in. It might be times in our lives when we felt deeply unsafe at a body level. Any of these can leave a nervous system more primed for hypervigilance, risk spotting and safety planning. None of this is your fault, and none of it means you’re not coping.
Put that together with the huge responsibility of a newborn, and you have the perfect conditions for intrusive thoughts. A new mother, without the embodied wisdom of having done this before and knowing she's capable of meeting her baby's needs, is especially vulnerable.
Why intrusive thoughts target what matters most
Our brains are built with a bias towards detecting threat, in order to keep us safe. So intrusive thoughts prey on our greatest fears.
As a mother, you conceived, grew and birthed your baby. You are their first attachment, and you are wired to keep them safe. So the thought of causing them harm is the one that horrifies you the most. That is exactly why these thoughts cause women so much distress. They are the opposite of everything you want and everything you value.
Having the thought does not mean you will act on it
Normalising intrusive thoughts is the first step in treating them, it takes the heat out. Having the thought does not mean you are at greater risk. It does not predict that the thing you fear will happen, or that you will act on it.
Why fighting intrusive thoughts makes them stronger
Most mothers who are distressed by these thoughts avoid them, resist them, and try to run from them. It makes complete sense. But it creates an association in the mind that the thought is a problem: that you are dangerous for having it, and you need to do something about it. That gives the thought more power.
There's an analogy of the Chinese finger trap that does a good job of demonstrating what happens when we fight or resist the thing, and when we approach or accept it. When you put a finger in each end and pull hard to get free, the trap tightens. The way out is the opposite of what feels natural: you stop pulling, and ease towards it.
What to do instead of fighting the thought
What we do instead is notice the thought and get curious about it. Nobody wants these thoughts, so this isn't about welcoming them in with open arms. It's about not meeting them with resistance and fear.
The ultimate goal is for the thought to become benign: no big emotional reaction, just "oh, that's the thing that happens." That won’t be where you start, and that’s okay. For some, the first step is feeling irritated by the thought instead of frightened by it, and that is progress. Over time, you change your relationship with the thought, in whatever way fits you best.
If you're reading this and thinking that's impossible, because you're so consumed by it, or the risk feels so real, I want to offer some hope. I also support many women who have these thoughts and find them annoying rather than terrifying. They've learned that the thoughts are not a reflection of them as mothers, and not a sign of any real risk. It may be that you continue to be prone to them. But they can lose their power.
I can also give my own examples. As a child sitting in a quiet school assembly, I had the thought that I could just stand up and start shouting. The fear was embarrassment, even being ostracised. As an adult, standing at the top of a tall building with a low railing, I've had a flash of "I could just jump", and the anxiety that rises in your body is so uncomfortable. I didn’t want to do either. Intrusive thoughts are a normal part of being human. Your brain plays out the worst case scenario, possibly to remind you of your vulnerability and your desire to survive.
So part of the work is being grateful to yourself for the reminder. You value your life. You value your baby's life. You love them, and keeping them safe is your absolute priority.
If a thought like this ever feels like something you actually want, rather than something that horrifies you, that is different, and needs support. There’s more on that further down.
When it needs more support
For many people, understanding that these thoughts are normal, and learning not to fight them, is enough. That is a real and valid way through.
Sometimes the distress is more intense or harder to shift, or it affects how you're able to function day to day. That’s when one-to-one support may be needed. It can point to something more going on beneath the surface, such as perinatal obsessive-compulsive disorder, or the effects of earlier trauma.
Talking therapy is a good place to start, and for some people it’s enough. There are well-evidenced approaches available through the NHS, including specialist CBT for OCD and EMDR (eye movement desensitisation and reprocessing) for trauma. I also see real value in other approaches alongside these, for example some women find gentle breathwork with a practitioner who understands where your nervous system is at, or craniosacral therapy, helpful.
And sometimes what helps most is less clinical: finding your community, your people, a place where you feel safe, where you can exhale and feel held. What that looks like is different for everyone, and it’s about what safety means to you, and where you are on your own unique journey.
When thoughts of harm need urgent help
There is a difference between an intrusive thought and a situation that needs urgent support. Intrusive thoughts are unwanted, they horrify you, and you pull away from them. But sometimes a mother is having thoughts of harming herself or her baby that feel real, or wanted, or she is feeling real anger or rage, or she feels confused, unlike herself, or out of touch with what's real.
This is rare, but it needs urgent help from professionals. It is usually the sign of a woman who is overwhelmed and unsupported, and that is a failing of our society, not of her. We don't set women up well for matrescence and the perinatal period. Partners often get only two weeks of leave before returning to work, and many of us live far from family.
If this is you, please get help today:
Ask for a same-day appointment with your GP, and tell them it's urgent. They can refer you to your local NHS perinatal mental health team.
If you are in the early weeks after birth, your midwife or your health visitor can also refer you.
Call NHS 111 and ask for mental health support.
Go to A&E for immediate help from a mental health professional.
If you or your baby are in immediate danger, call 999.
Specialist mental health mother and baby units admit women with their babies up to the age of one.
If you feel suddenly confused, very unlike yourself, or are seeing or hearing things that others don't, treat it as an emergency and go to A&E or call 999.
If you're struggling right now
If you are struggling right now, I want you to know a few things. You are not alone. I sit with women regularly who are carrying exactly this, and not one of them is a bad mother. Having these thoughts doesn’t mean you’ve done anything wrong.
You are holding so much, often with far too little support. We don't live in a world that nurtures and prioritises the health of mothers and their babies, and that isn’t your failing. Please reach out to someone today, whether that’s your GP, your midwife, or me. Asking for help is part of looking after your baby.
If this resonates with you, I'll be back with more soon, some reflective and some practical, all aimed at helping you feel less alone in this. And if you know a mum who might need to read this today, please share it with her.
I'm Alex, a BABCP-accredited CBT therapist, perinatal mental health nurse and doula. If you'd like to talk, I offer a free 30-minute connection call to see if I'm the right fit for you. I can’t offer emergency support, so if you need help today, please use the options above.