Things they don’t tell you: Intrusive Imagery after childbirth

You find yourself pregnant, either unexpectedly, or as part of your plans and dreams for the next chapter of your life. Your reaction to the news may be joy, fear, worry, panic, ambivalence or anything in between. You see your doctor, consider what this might mean for your life, and buy pants with an elastic belly band.

Months go by, and either toward the end of pregnancy or sometime after your baby arrives, a strange and frightening thing happens- you are walking down the hall toward the kitchen when out of nowhere a horrible, graphic image of something horrible happening to your baby suddenly enters your mind.

You visceral reaction is horror, which quickly turns to a different sort of fear. You might ask yourself if this is some kind of premonition, a mothers’ instinct thing. You start finding ways to try to prevent the horrible scene from happening for real- the mother who visions her baby drowning after falling into the family pool avoids all water deeper then the baby bath, the mother who visions her baby harmed with a kitchen knife refuses to touch the knives anymore or puts them away, only to take them out if the baby is in a separate room…..

Or perhaps you begin to wonder if this is a sign that you yourself might be a risk to your baby. Mind you, the vision horrified you and you would never want to see your baby harmed, but it was so vivid. Could this mean you are having a serious problem and cannot be trusted? Could it be post partum psychosis starting?

Many, many women experience something similar to this. In fact, I did, thankfully briefly, after having each of my kids. And not just once- there were a few images that happened repeatedly for awhile. This experience is called intrusive thoughts or imagery, and is extremely common in late pregnancy and in the months following birth. The thoughts and images just pop into your mind, and are often very graphic. And they are not necessarily a sign of a mental health problem. However, in some cases our response to them can cause them to worsen or linger.

The cause of these thoughts and images isn’t completely clear. The significant hormonal changes of late pregnancy and the post partum period may play a role, along with sleep deprivation, the life changing nature of having a baby and the weight of responsibility for a helpless little being in a very big world. Whatever the cause, be assured that though they are highly disturbing, they are also common and in most cases they will pass, so long as we respond to them in ways that do not reinforce them.

No matter your situation, the decision to become a parent for the first, (or second, or third…) time is life changing.  I myself am a parent of two, and in my practice as a mental health professional, I work with many parents from all walks of life. Many mothers have described these “intrusions” as we call them, but only after being asked directly. The reason few women report these experiences is often fear- fear of judgement, of other’s fearful reactions, of being labelled a risk to their baby and having child welfare called. This fear promotes the silence around these experiences, creating an inability for other mothers to understand and normalize the experience.

For many, the most natural reaction after having an intrusive image or thought is to take measures to prevent the frightening thing from happening. For example, parents whose intrusion involved their infant being harmed in a car crash might avoid driving with their baby, or only allow one or two highly trusted people to drive with the baby in tow. Others who have envisioned falling down the stairs holding their babies no longer take them up the stairs, or travel stairways with their baby in a seated position. This avoidance of similar, but low risk real life situations is very natural and understandable, but can be very unhelpful.

Firstly, it can be isolating. most others observing this behaviour will not understand it, as it does not make sense unless you are aware of the nature of the intrusion- and remember, most parents tend to keep that quiet. This can cause tension and misunderstanding with partners, parents, friends and others who are important supports to families with young children. Anyone who is an engaged parent knows that being misunderstood or judged about our parenting from those we value is extremely painful. There is nothing worse for parents of a young baby than social isolation, and no bigger reason for people to want to avoid others then feeling judged!

Secondly, when we avoid something that scares us but which is not actually likely to be harmful, it reinforces our fear. What this means is that the more we avoid, the more anxious we will feel about the avoided thing. Basically, we are biologically wired for survival, and part of this is our “fight/flight/freeze” system. this system is a feedback loop- so our response to it can determine if we see a given situation as a risk or not. In a nut shell, when we perceive something as a threat and we avoid it successfully, then feel relief, this sends a message to our brain (to the amygdala specifically) that the thing we were scared of was a real, major threat, and we survived by getting away- therefore, next time, our brain will be on high alert for another similar situation so it can help us get away again.

Over time, our brain learns more about the signs related to the feared situation, and will make us anxious and fearful not just in the situation, but when we are faced with things that remind us of the situation. For example, a caveman meeting a saber toothed tiger the first time runs away and luckily escapes. However, because he got close to the higher, he also smelled it. Unbeknownst to him, his clever caveman brain coded that scent as an indicator of coming threat. So a week later when he walks by a cave and smells that smell, he finds himself afraid and running away almost automatically- well before sighting the tiger. this helps the caveman survive. However, in modern life where most things are relatively safe (comparative to caveman days, anyhow) this can cause us problems. A person may easily find themselves at first anxious driving with their baby, then with anyone driving with their baby, then near cars with their baby, and finally even looking at pictures of cars.

Thirdly, we can assign unhelpful meanings to intrusions. Here again, the lack of education available about this plays a role. Many people who experience post partum intrusions interpret them as a sign they are going crazy, or are untrustworthy around their children. Others feel confident that while the intrusion was disturbing, they would never be a risk to their child- but assume that others will never understand and may see them as such. Sometimes this can be reinforced by medical professionals and loved ones- again, because they do not understand the nature of intrusions.

So what to do if you are having intrusions?

First, prioritize rest and self care. This advice is always given to new parents for a reason! For me, the first year with my babies was easily the toughest thing I have ever encountered in my life, physically, mentally and emotionally. Even though it’s hard, reaching out to family and friends to get breaks is very important. We are more at risk for low mood, high anxiety and intrusions when our own needs are not being met. And lets face it- if you have a new baby, your needs are probably not even on the stove, let along the back burner. If you have family or friends you think will understand, you can tell them about the intrusion, and can direct them to this post and some of the links to help them grasp what you are going through more clearly. Many women I have worked with were surprised to find that when they shared their experience with others, they often heard other say “me too”. Reaching out to others helps us nurture our connections outside of parenthood, creating some life balance, and combatting the isolating effect of intrusions.

Secondly, as much as possible, minimize avoidance. Notice when you are wanting to change your habits, routines and general behaviour due to fears of the intrusion occurring or coming true. The goal here is to send the message to your brain that “I did nothing to get away from this situation and everything was fine- you can stop having this reaction now, brain”.

Thirdly, and this goes along hand in hand with minimizing avoidance, educate yourself about intrusions and normalize them as much as you can to avoid making unhelpful interpretations of their meaning. it is far less scary to think “Oh this is an unpleasant intrusion. I wish it would not happen, but it dose’nt mean anything bad is actually going to happen. It may feel horrible, and that is a sign I love my baby and will protect my baby from everything I can in life.  After all, I hate even thinking about something happening to him or her!” then, “This image is horrible! I wonder if this is a premonition or mother’s intuition? What if this is a sign I am losing my sanity? Can I trust myself? What would others think if they knew? How can I prevent that image from actually coming true?”. Our thoughts and interpretations are part of what determines what we see as a threat, so we have to change them as well as minimize avoidance to get our fight/flight system to stop making us feel panicked when intrusions arise.

Most of the time, intrusions will pass on their own. Many parents experience them, but don’t see them as a problem, rather as a sign of the natural tendency of loving parents to be overwhelmed by the task of keeping their children safe from so many unforeseen risks int the world. However, of your intrusions do not pass or become less frequent within a few weeks of following the above suggestions, you may wish to contact a mental health professional for further help in reducing these.

It is important to note that post part depression and anxiety can, on rare occasions, cause serious thoughts of harm to self or to the baby. Intrusions are different from this in that when someone has an intrusion, their reaction to the image of their baby being harmed is horror. There is no behavioural urge to harm the child whatsoever, and many parents affected take extensive precautions to ensure no harm comes to their child. Additionally , intrusions are often related to situations where actual risk of harm is very low- for example, the baby sliding out of the mother’s arms into the pool. The likelihood of this happening is objectively  low, but the fear the parent feels makes it seem like it is almost certain to happen. When someone is truly thinking of harming their baby, they do not feel horror about the act of harming the child- the act its self seems tempting. If you or someone you know is experiencing this, it is a sign of severe post part depression and requires that person to access help immediately by accessing your local emergency room or crisis intervention program.

What have your experiences been with intrusive images?

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