Postpartum OCD: When Scary Thoughts Show Up in Pregnancy and After Birth

Pregnancy and new parenthood are often described as magical…and they can be. But they can also be packed with fears, “what ifs,” and a level of responsibility that feels absolutely huge. If you’ve ever had a sudden, disturbing thought like: What if I drop the baby? Or: What if I hurt my baby on purpose? and it left you panicked and ashamed, you are not a bad parent—and you’re not alone.

These intrusive thoughts can sometimes be a symptom of postpartum anxiety or perinatal obsessive–compulsive disorder (perinatal OCD), a common and very treatable mental health condition that can begin during pregnancy or in the first year after birth.

What is postpartum OCD?

OCD is a mental health condition that involves:

• Obsessions: Unwanted, repetitive thoughts, images, or urges.
• Compulsions: Behaviors or mental rituals you feel driven to perform to reduce anxiety or prevent something bad from happening.

When OCD starts or worsens during pregnancy or after birth, it’s called perinatal OCD (also called maternal or postpartum OCD). The International OCD Foundation notes that perinatal OCD often centers on fears of harm, contamination, or loss involving the baby, and may include intense checking, cleaning, or avoidance rituals.

How common is postpartum OCD?

Postpartum OCD is more common than many people (including providers) realize. The Policy Center for Maternal Mental Health estimates that maternal/perinatal OCD affects up to 5% of pregnant and postpartum people, and overall, OCD is more prevalent in the perinatal period than at other times in life.

What does postpartum OCD feel like?

Perinatal OCD tends to latch onto whatever you care about most—like your baby’s safety and your identity as a loving parent.

Common obsessions (intrusive thoughts or images) include:

• Graphic images of accidentally hurting your baby (dropping, suffocating, cutting with a knife, etc.)
• Disturbing thoughts of intentionally harming or sexually abusing your baby, even though the idea horrifies you
• Intense fears of germs, contamination, or illness (“What if I give my baby a deadly infection?”)
• Fears of being a “dangerous” or “unfit” parent, or of making a catastrophic parenting mistake

Common compulsions include:

• Excessive cleaning or washing of hands, bottles, clothes, or surfaces
• Checking rituals, like repeatedly confirming that the baby is breathing or replaying the day to “make sure” you didn’t hurt your baby
• Avoidance, such as refusing to bathe, carry, or be alone with your baby out of fear of what you might do
• Seeking reassurance over and over (“Are you sure I didn’t hurt the baby?”)

Parents with perinatal OCD usually recognize that these thoughts are unwanted and out of character—but they feel responsible for preventing any possible harm, so they get stuck in a loop of worry and rituals.

Intrusive Thoughts vs. Real Risk

While intrusive thoughts are common, acting on them is not.  An estimated 70 to 100% of new mothers and fathers report intrusive thoughts of accidental or intentional harm to their baby—even when they do not have OCD.

The difference in perinatal OCD is how those thoughts are interpreted. Parents with OCD read meaning into the thought (“If I thought it, maybe I want to do it”) and feel intense shame and panic, which leads to rituals and avoidance.

Research on intrusive thoughts of infant harm shows that these thoughts are not associated with actually harming the baby, but they can be linked with higher anxiety and OCD symptoms.

Why does postpartum OCD happen?

There’s no single cause, but experts believe several factors combine:

• Biology and hormones: Rapid shifts in hormones like estrogen, progesterone, and oxytocin may make the brain more sensitive to anxiety and “threat detection.”
• Protective instincts gone into overdrive: The very system designed to keep your baby safe can overshoot and turn into constant “what if?” scanning.
• Stress and sleep loss: New parenthood often means broken sleep, physical recovery, financial stress, and limited support—all of which can worsen OCD.
• History of mental health conditions: A personal or family history of OCD, anxiety, or depression increases risk. Some studies also link higher risk to previous insomnia, trauma, or perfectionistic personality traits.

Postpartum OCD vs. “Normal” Worry and Postpartum Psychosis

Of course, some worry is normal for new parents! So how do you tell the difference between a normal amount of worry and something more serious?

You may be dealing with perinatal OCD rather than everyday anxiety if:

• Intrusive thoughts are frequent, vivid, and very distressing.
• You spend a lot of time on rituals or mental reviewing.
• You avoid your baby or routine caregiving tasks because of fear.
• The thoughts feel completely against your values and you’re horrified by them.

It’s also different from postpartum psychosis, a rare but serious condition. In postpartum psychosis, people may have delusions or hallucinations and poor insight—they may believe the scary thoughts are true or feel driven by voices or outside forces. In perinatal OCD, thoughts are ego-dystonic—they feel foreign, wrong, and deeply upsetting. That distress is actually a sign that you don’t want to act on them.

If you ever feel you might act on harmful thoughts, or you’re seeing or hearing things that others don’t, treat it as an emergency and get immediate help.

How is postpartum OCD treated?

The good news: Perinatal OCD is highly treatable, and early treatment can protect parent–baby attachment and family wellbeing.

Therapy (CBT with ERP)

Current reviews and clinical guidelines agree that cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is a first-line treatment for perinatal OCD. ERP gently and gradually helps those suffering with postpartum OCD face feared situations (like holding the baby near the staircase) while not doing their usual compulsions (like avoiding or over-checking). Over time, their brain learns that they’re safe and so is their baby—even without rituals—and the intrusive thoughts lose their power.

Organizations like the International OCD Foundation and Postpartum Support International offer provider directories to help you find therapists experienced in perinatal OCD.

Medication

For moderate to severe perinatal OCD, medication plus therapy is often recommended. SSRIs (selective serotonin reuptake inhibitors) are the most studied medications in pregnancy and breastfeeding and are considered first-line for OCD. Decisions about medication during pregnancy or lactation involve weighing the risks of treatment vs. the risks of untreated illness, which can also affect parent–infant bonding and overall health.

Talk with a clinician who understands perinatal mental health—such as a reproductive psychiatrist, OB/GYN, or family doctor with this expertise—about your specific situation. Don’t stop any psychiatric medication suddenly without medical guidance.

When to Reach Out for Help About Postpartum OCD

Tell your healthcare provider if you notice any of the following:

• Intrusive thoughts that frighten you or won’t leave you alone
• Spending more than an hour a day on worries, rituals, or checking
• Avoiding being alone with your baby, or feeling disconnected from your baby
• Feeling hopeless, ashamed, or like your family would be better off without you

If you think you might hurt yourself or someone else, call or text 988 for the Suicide & Crisis Lifeline, or call 911 (or your local emergency number). You can also contact Postpartum Support International for free help connecting to local resources and support groups.

How Partners, Family, and Friends Can Help

Loved ones can play a powerful role in recovery. You can:

• Learn about perinatal OCD (starting with resources like IOCDF’s fact sheet and the Policy Center for Maternal Mental Health).
• Listen without judgment. Remind your partner that intrusive thoughts don’t reflect who they are.
• Encourage them to talk openly with a provider and support getting to appointments or virtual visits.
• Offer practical help—night feeds, chores, childcare for older siblings—so they can rest and attend therapy.
• Gently help your loved one reduce reassurance-seeking and rituals while still being warm and supportive—with their therapist's guidance.

A Final Word of Hope

Postpartum OCD can make the early months of parenting feel terrifying and lonely. But this condition is not your fault, not your identity, and not forever. With the right help, most parents get much better and go on to enjoy life with their little one. Speaking up is not a sign that you’re a “dangerous” parent—it’s a sign that you’re a brave, loving one who deserves support.

More on Parental Mental Health:

• Mental Health Resources for New Parents
• The Happiest Baby Postpartum Mental Wellness Toolkit
• Postpartum Mental Health Tips to Stop Believing
• Top Triggers for Postpartum Depression

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REFERENCES

• Blenders, Hammers, and Knives: Postpartum Intrusive Thoughts, Anthropology & Medicine, 2022
• Perinatal Obsessive–Compulsive Disorder: Epidemiology, Phenomenology, Etiology, and Treatment, Current Psychiatry Reports, April 2022
• International OCD Foundation: Perinatal OCD — What Research Says About Diagnosis and Treatment
• Postpartum OCD Fact Sheet, International OCD Foundation, 2014
• Maternal OCD, Maternal Mental Health Leadership Alliance & Policy Center, 2025
• Exploring the Clinical Features of Postpartum Obsessive‑Compulsive Disorder (PP‑OCD): A Systematic Approach, Journal of Clinical Psychology, 2023
• Anxiety & Depression Association of America: Unexpected OCD Postpartum
• Postpartum Support International: Perinatal OCD — Part I
• Cedars‑Sinai: The Difference Between Postpartum Anxiety, OCD & Psychosis

Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.