Postpartum University® Podcast

A Functional Approach to Postpartum Intrusive Thoughts vs. Postpartum OCD EP 240

• Maranda Bower, Postpartum Nutrition Specialist

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Let's be real: telling a terrified mom that her horrific intrusive thoughts are "normal" is only half the story, and it's not good enough.

This episode is your new essential guide. We're cutting past the surface talk about "scary thoughts" and diving deep into the neuroscience of what's actually going on. Your client's brain is doing a brilliant, protective job being hypervigilant, but then sleep deprivation, nutritional depletion, and chronic stress turn that protection into a panic spiral. We explain exactly how to spot the difference between a normal thought and pathological Postpartum OCD and, most importantly, how to offer root-cause solutions that stop the nervous system from fueling those terrifying images. If you want to move beyond just screening and genuinely help your clients heal, you need to hear this.

Check out the episode on the blog HERE

Key time stamps: 

1:03  Naming the Unspeakable: What Do Postpartum Intrusive Thoughts Really Look Like?

2:34  Why Telling a Mom "It's Normal" Simply Isn't Enough (and Why It's Harmful).

5:57 Maternal Brain Plasticity 101: How Evolution Made the Postpartum Brain Brilliant.

8:18  Hypervigilance, Sympathetic Dominance, and The Postpartum Energy Debt.

10:58  The Spiral: When a Protective Thought Leads to Pathological Anxiety.

14:25 Root Causes Driving Postpartum Nervous System Dysregulation.

17:54 Case Study: Resolving Severe Nighttime Intrusive Thoughts with Nutrition (Ferritin & Labs).

20:22 Case Study: Feeding Anxiety, Blood Sugar Crashes, and Adrenal Support.

22:09 The Critical Distinction: Intrusive Thoughts vs. Postpartum OCD (P-OCD).

25:12 The Whole-Person Assessment Framework for Intrusive Thoughts.

27:08  Layered Interventions That Work: Regulation, Foundations, Trauma, and Support.

29:27 Common Provider Mistakes: Minimizing, Catastrophizing, and Isolating Symptoms.

32:17  Intrusive (Ego-Dystonic) Vs. Psychotic (Ego-Syntonic) Thoughts: Why This Distinction is Life-Saving.

35:17  Partner Education: Helping Support People Provide Help, Not Judgment.

37:47  Building Resilience, Not Symptom Suppression: Long-Term Nervous System Health.

NEXT STEPS:

SPEAKER_00:

The postpartum care system is failing, leaving countless mothers struggling with depression, anxiety, and autoimmune conditions. I'm Miranda Bauer, and I've helped thousands of providers use holistic care practices to heal their clients at the root. Subscribe now and join us in addressing what modern medicine overlooks so that you can give your clients real lasting solutions for lifelong well-being. Welcome back to the Postpartum University Podcast. Miranda Bauer here. And today we are diving into one of the most terrifying aspects of postpartum that no one talks about. And honestly, just it's not a conversation enough. And that's intrusive thoughts. And I'm not talking about the gentle clinical way most trainings cover this. I'm talking about the raw, terrifying reality that mothers experience and the neurological reasons why this happens and why we've turned this normal biological response into a psychiatric diagnosis. Because what's actually happening is that your brain is doing exactly what it's supposed to after having a baby. The problem isn't the intrusive thoughts. The problem is that we're not giving mothers the support their nervous system needs. So normal brain functions spiral into dysfunction. So today we're gonna unpack this neuroscience of intrusive thoughts, why they're biologically normal, how to uh, how how lack of proper postpartum care creates the conditions for them to become pathological, and what we can do as providers and what we need to understand to support mothers through this. This is going to be a deep dive into how the postpartum brain works, why it's actually very brilliant, even when it feels broken, and how we can support normal biology before it turns into something else. Let me start with what intrusive thoughts actually look like, because I think so many providers don't fully grasp how terrifying these are for moms. If you're a mom listening in and you might be triggered by this, you might want to skip for a minute or so in this part of the episode. But I really want to paint the picture of what we experience as moms, myself included. I had this. Many providers who are moms have experienced this as well. It's the thoughts of when we're holding our newborn near and we're by the stairs, and suddenly we have this vivid image of dropping the baby down the stairs. And like we can see it happening. We know exactly how it hits their head and everything occurs. We might even imagine the sound. It's so real that it takes our breath away. Or she's giving the baby a bath and has this flash image of holding the baby's head underwater just for a second, just the thought, but it's there. Or she's driving with the baby in the car and imagines herself purposely swerving onto incoming traffic, or she's standing in the kitchen holding the baby with the knife block right there. And then all of a sudden, there's this image of stabbing the baby. And these aren't vague worries. These are intrusive, unwanted, graphic, disturbing thoughts and images that feel completely out of character and they are absolutely horrifying. And here's what happens: that mother becomes terrified. She thinks she's a monster. She thinks something is deeply wrong with her. She's afraid to tell anyone because what if they take her baby away? But at the same time, is she dangerous? Is she too dangerous for her baby? And so she suffers in silence, which makes everything worse. And then she's actually more likely to have more of those thoughts because she's already in a state of hyperviligence about those thoughts. She's afraid of them. And when there's fear, there's more thoughts. Now we have made some progress in recent years normalizing the concept of intrusive thoughts. So you see it on social media posts saying intrusive intrusive thoughts are normal. There's a book out there, we talk about the scary thoughts, and that's really good. It's better than complete silence. But here's where I have a problem with how we've normalized them. We've basically said, yep, totally normal. Lots of moms have them, don't worry about it. Without explaining why, why, why they happen or what to do about the underlying causes? It's like if someone came to you with severe joint pain and you're like, oh yeah, it's totally normal and postpartum. Lots of women have it. And you don't investigate whether it's a normal biological change. Is it nutritional deficiencies? Is there something that's happening in our space, in our world, in our environment? Is it an autoimmune condition developing? We've normalized intrusive thoughts without contextualizing them within this broader postpartum recovery picture. Because yes, some level of intrusive thoughts is biologically normal in early postpartum. But when they're frequent and distressing and they're interfering with daily life, that's not just normal postpartum stuff to endure endure. That's a nervous system that is struggling because it's not getting what it needs. So let's talk about what's actually happening in postpartum, particularly the brain, because this is fascinating and it will completely change how you understand intrusive thoughts. So during pregnancy and postpartum, the maternal brain undergoes massive restructuring. This isn't metaphorical, actual gray matter volume changes in specific regions of the brain. So areas responsible for threat detection, empathy, caregiving behaviors literally grow and become more active. This is called maternal brain plasticity. And it's one of the most dramatic examples of neuroplasticity in the human experience. And it happens in postpartum. And the purpose of this rewiring is to make mothers incredibly attuned to their baby's needs and hyper-aware of potential threats. This is how our species have survived. Mothers whose brains become hypersensitive to danger were better at keeping their babies alive. And part of this rewiring involves the amygdala. Okay, your threat detection center is the amygdala, and it becomes more reactive. And your brain is literally rewiring itself to sense danger more acutely. It's such brilliant evolutionary design. But here's where the problem in our modern context develops. This heightened threat detection system requires proper support to function correctly. It needs adequate rest, proper nutrition, nervous system regulation, and social support so that it can stay calibrated. And when those needs aren't met, when a mother is sleep deprived, nutritionally depleted, chronically stressed, socially isolated, this threat detection system goes into overdrive. And let's talk about what happens energetically when a nervous system is operating in this hypervigilant state. The nervous system is running in sympathetic dominance. So that fight or flight state. It's incredibly energy sensitive. Your brain is constantly scanning for threats, your body is maintaining high cortisol and adrenaline. Your muscles are tense, your digestion is suppressed. This burns through enormous amounts of energy and nutrients. And the postpartum brain already has massive energy demands. It's coordinating milk production, it's regulating new hormone patterns, it's managing the massive structural changes that I just talked about. Now, on top on top of like your body already doing all sorts of other significant changes and healing processes, right? The coordinating of all the complex behaviors required for infant care is astronomical. And when you add chronic sympathetic nervous system activation on top of these already high demands, the system starts breaking down. And one of the first things to suffer is the prefrontal cortex, that part of your brain responsible for rational thinking, impulse control, modulating emotional responses. The prefrontal cortex requires enormous amounts of energy to function, right? And when energy is scarce, it's one of the first systems that gets compromised. So now we have a mom's brain who is hypersensitive to threat, whose prefrontal cortex isn't functioning optimally to regulate those threat responses, and whose nervous system is struck, stuck in overdrive. It's like the perfect storm for intrusive thoughts to become overwhelming. And then here's how the spiral typically happens. And this is crucial for providers to understand. Step one, the mom has this intrusive thought. Maybe she's holding her baby near the stairs. She has this flash of what would happen to her baby. Maybe she drops the baby. And this thought itself is actually a function of the hypervigilant threat detection system. Her brain is running what if scenarios to keep her baby safe, right? And in the ideal scenario, she would be like, oh, thank you, brain. I got it from here. I know that going down a flight of stairs is more dangerous than walking a straight path, but it's what I got to do, and I got it under control, and we're good. But that's not normally what happens. Normally she goes into step two because her prefrontal cortex is compromised and her nervous system is already on high alert. She can't quickly dismiss this thought as just her brain doing its job. So instead, she has this strong emotional reaction. She has fear, horror, shame. How in the world did I just think that? How grotesque, how awful. And then step three happens. This emotional reaction signals to her amygdala, this is important. This is dangerous. Pay attention. So her brain starts producing more of these thoughts that amygdala is trying to solve a problem. If thinking about the baby getting hurt is causing this much distress, it must be a real threat that needs attention, right? It's that brain feeling like it's being chased by a lion. And then step four happens more intrusive thoughts, which lead to more distress, which leads to more thoughts. And the mother starts avoiding situations that triggers those thoughts. Maybe she stops going near the stairs or she stops bathing the baby, or she stops driving with the baby. And then step five happens, the avoidance confirms to her brain that these situations are dangerous, which intensifies the intrusive thoughts even more. And then step six, meanwhile, this constant anxiety is further depleting her already compromised energy reserves. It's making her prefrontal cortex function even worse, which makes it even harder to regulate her thoughts. This is how normal maternal brain functions become postpartum OCD or severe anxiety. And here's what makes me frustrated about the current approaches. We're teaching or we're treating the intrusive thoughts as the problem rather than a symptom of a deeper dysfunction. So when a mom comes in with distressing intrusive thoughts, the standard approach is we're screening for postpartum OCD or anxiety, maybe prescribe medication, we're referring to therapy, teach thought stopping techniques. And these interventions can be helpful, absolutely helpful. I'm not saying that they're useless, but we're not asking why is her nervous system so dysregulated that normal maternal brain function has become pathological. So we need to look at what are the root causes. And I'll tell you what those are sleep deprivation, first and foremost. We've got chronic sleep disruption that directly impairs that prefrontal cortex function. Even six hours of fragmented sleep affects cognitive function more severely than three hours of consolidated sleep. Sleep deprivation also dysregulates the HPA access. It's keeping cortisol elevated and the nervous system in the sympathetic dominance. We also have nutrition depletion, one of the most foundational components to everything I teach. The brain requires specific nutrients to produce neurotransmitters that regulate mood and anxiety. Magnesium deficiency affects GAVAR production and nervous system regulation, B vitamin deficiencies affect neurotransmitter synthesis, omega-3s deficiencies, they affect brain structure and function, iron deficiency affects oxygen delivery, all of these things, right? And when you are in a state of nervous system dysregulation, you are eating up tons of energy and you are requiring even more. So in postpartum, while you're healing, which is already nutritionally demanding, while you're breastfeeding, which is also nutritionally demanding, now you have a nervous system that is requiring even more nutrients. And we have chronic stress. When stress is constant rather than intermittent, that HPA axis becomes dysregulated, cortisol patterns flatten, the nervous system loses its ability to downregulate, everything becomes a potential threat. We have inflammation, right? Acute inflammation is absolutely necessary and early postpartum. We want that. But when our bodies are not cared for, it becomes chronic inflammation. And that directly affects brain function. We have pro-inflammatory cetokines that cross the blood-brain barrier and alter neurotransmitter metabolism. And inflammation is strongly linked to anxiety-intrusive thoughts. Lack of nervous system regulation, we've talked about that trauma, birth trauma or historical trauma within the body. Whether it's something that's been passed down generationally, oftentimes it's something that's occurred in childhood or uh even in an adulthood. That trauma keeps the nervous system hypervigilant. Unresolved trauma makes the brain interpret everything through a lens of danger. And then when we add these root causes, the intrusive thoughts often resolve or become manageable without pharmaceutical intervention or extensive therapy. And I'm going to give you a couple of real-world examples from our training network. I have uh Doula, who had a client with severe intrusive thoughts starting around six weeks postpartum, graphic, disturbing images of harming her baby. The client was terrified, crying constantly, barely sleeping, even when she had the chance, because the thoughts were significantly worse at night. And the standard approach would be to immediately refer for psychiatric help, right? Absolutely. Absolutely. And that's exactly what this doula did. And she had also been through our perenatal mental health training. So she also asked some really important questions. When did you eat last? What are you eating typically? Are you having digestive issues? What do you experience? How do you view your birth experience? What kind of support are you getting at home? And it turns out this mom was barely eating when that doula wasn't present. She was having maybe one meal a day and a handful of snacks throughout the day, but nothing of substance except for one meal. She had a traumatic birth with heavy blood loss. She was exclusively breastfeeding. Her partner had gone back to work and she was alone all day with the baby, except for when the doula came, which couldn't be all the time, you know? And so this doula, she was helping her get some questions ready for her provider. She gets uh uh the postpartum mom gets some comprehensive labs done. Her ferritin was at four, her magnesium was low, her B12 was borderline, her cortisol was completely dysregulated. It wasn't even showing up as a marker anymore. It was like dead. And they focused on aggressive nutrition repletion, nervous system regulation practices, and connecting her with her with a birth trauma therapist. And within weeks, that intrusive thoughts, she she went on a wait list for a therapist, which is very common, unfortunately, in today's world. And so while she was waiting, they were doing these other things. And within two weeks, those intrusive thoughts decreased significantly. And within a month, within a month, as she's waiting to get into therapy, she was she felt like everything was manageable. She still had uh intrusive thoughts, but they were not distressing or interfering with her life. There's another example. There was a lactation consultant who took our training. She noticed that her client seemed anxious during feeding sessions or asking repetitive questions about if the baby was okay, if she was doing it right, if she was getting enough. And then when the lactation consultant gently asked more questions, the mom disclosed that she was having a lot of intrusive thoughts about the baby choking or suffocating while breastfeeding. And she had been told that these thoughts were normal. She had talked to her friends, all of these things, and she just felt like she couldn't ignore them. They were, they were getting worse, and it was making her really, really fearful. And every time that she breastfed, she was holding so much tension within her body. So the lactation consultant looked at the bigger picture. This mother was drinking multiple energy drinks daily because she was so exhausted. She had been on hormonal birth control for 15 years before getting pregnant, which we don't have time to cover here, but dramatically influences the brain. And her diet was mostly quick carbs. She was eating crackers and toast and granola bars because she didn't have time or energy for like real meals, but she was just grabbing whatever she could out of the pantry. And they can they connected on stabilizing her blood sugar, right? Supporting her adrenals, addressing the nutrient depletion from long-term birth control use. They also worked on nervous system regulation during feeding specifically. And the intrusive thoughts disappeared completely. She was having blood sugar crashes, y'all. She was very, very nutrient depleted. She needed more sleep. And there needed to be some nervous system regulation practices, deep breath exercises, those kinds of things to really support her nervous system in healing. And I want to be really, really clear about something. There is a difference between normal intrusive thoughts and postpartum OCD. And providers have to understand this distinction. Normal, intrusive thoughts and postpartum occur occasionally. They're often triggered by specific situations, they're just stressing, but the mom recognizes their thoughts, right? Even though they might feel really awful, they don't really interfere with daily functioning. And the mother doesn't believe that she's going to act on these things. And when the nervous system is regulating, they decrease. Postpartum OCD are when these thoughts are frequent, they're persistent, they're consuming, and they're often accompanied by compulsive behaviors that try to prevent the fear of or the event that they had witnessed within their head. And it significantly interferes with daily life. That mother may have trouble distinguishing thoughts from reality, which becomes psychosis. And it gets worse over time without intervention. And the mom feels driven to sometimes even perform rituals to keep the baby safe. So this distinction matters because the intervention approach is different when that occurs. But even that, even when we address that postpartum OCD, we still have to address the underlying nervous system dysfunction, the nutritional deficiencies, the lack of support, the lack of sleep. Medication and therapy work much better when the body has what it needs so it can heal. And in our perinatal mental health training, we teach providers to assess intrusive thoughts within the context of the whole body system. So when a mom discloses intrusive thoughts, we're asking about the thoughts themselves, like what's the context, how frequent, how distressing, any compulsive behaviors in response? Does she believe she might act on them? And then we're also asking about the nervous system. We're talking about sleep quantity, quality, trauma history, current stress levels, signs of chronic sympathetic activation. Uh, what's her food intake like, digestive issues, recent lab work? Has that been done? Energy levels throughout the day. Who's there supporting mom? Does she feel safe asking for help? What's the quality of her partner's support? Is she isolated socially? These are comprehensive questions that take a lot more than five minutes to help answer. But it's necessary to help understand whether we're dealing with normal but distressing intrusive thoughts that will respond to nervous system support, or whether we're dealing with postpartum OCD that needs more intensive intervention. And when we understand intrusive thoughts as a symptom of nervous system dysregulation, rather than like a primary problem, our intervention approach changes completely, right? The first layer is immediate nervous system regulation. We have to address that nervous system and downregulate it right away. So breathing practices that activate parasympathetic response, physical grounding techniques, safe social connection, movement that regulates rather than activates, reducing unnecessary stimulation. And then the second layer is addressing physiological foundations. We've got to make sure she's getting the right sleep. We've got to make sure she's getting nutrient repletion. Her blood sugar is stabilized. We're decreasing inflammation. We're helping support her gut health. And then the third layer is processing trauma. If there's birth trauma or historical trauma, this has to be addressed. This nervous system will not fully regulate with unprocessed trauma, keeping it on high alert. And then the fourth layer is building support systems. That nervous system regulates in relationship. Mothers need mothering. They need actual support, not just advice to ask for help. And then we have psychiatric support when needed for severe cases or when other interventions aren't sufficient or possible in this time, you know, when a mother is extremely suffering with whatever it is that's going on in her life and she cannot cook meals and she can't afford to get support and everything feels like it's caving in. I've been there, I know that feeling. And so sometimes that's when those medications and that specialized therapy absolutely have its place. But they also, but, but, but, they also work much better when the foundation is solid. I want to talk about some of the common mistakes that I see providers making around intrusive thoughts. First is minimizing and saying things like, these are totally normal, all moms have them, without actually helping the mother understand why or what to do about them, which it leaves a mother feeling gaslit and alone. The second mistake I see is catastrophicizing, immediately assuming intrusive thoughts mean postpartum psychosis or that a mother is dangerous. And this terrifies moms and makes them less likely to be honest about their experiences, not with just us, but with everyone else that they come into contact with. They're less likely to get the help that they need if they feel like something really awful is going to happen to them, like their baby taken away. Mistake number three is treating in isolation, like addressing the thoughts without addressing the nervous system dysregulation and the nutritional deficiencies and the sleep deprivation and the lack of support that are driving them. Mistake number four is not differentiating, like failing to distinguish between intrusive thoughts, which is ego dystonic, like not me, and the psychotic thoughts, like ego syntonic. They make sense. This is such a critical distinction that we have to make sure that we are making all the time. I can't tell you how many times that I've worked with a mom who was recovering from psychosis. This was very common when I was working with moms one-on-one, and they were in this recovery phase after having experienced that. And they had been there for a really long time, and no one had supported them, no one had saw what they needed somebody to see. I've met so many women whose doctors never caught it. It's complete, it sounds so crazy to me, and it's horrifying to think that that occurred. I need to address this because it's crucial, right? Intrusive thoughts are not the same as psychotic thoughts. And providers have to be crystal clear on this distinction, right? We have intrusive thoughts, which could be OCD, right? We've got the ego dystonic, they feel like they're not me, they're distressing, they're not wanted. Moms recognize that this is this is wrong. And moms fear, they have fear of those thoughts. A psychotic thought is ego syntonic, right? It makes sense to that person. They may not cause it, they're not causing distress because they seem absolutely reasonable. And the mothers believe that these thoughts are true and and she may act on them. Uh, and it doesn't seem like a problem at all. So, for example, an intrusive thought is like I keep having this horrible image of dropping my baby down the stairs, and I'm terrified. I am terrified I might do it even though I would never want to hurt my baby. And the thought itself freaks me out. An example of psychotic thought is uh I think my baby is evil and I need to save them by ending their life, right? It's it's a very different thing. Or I have these horrible thoughts of dropping down my baby down the stairs, and maybe I will, and it's fine. So the distinction determines whether we're talking about anxiety or OCD, which is treatable with the approach I'm describing, versus psychosis, which is a psychiatric emergency requiring immediate intervention. The one thing we don't talk about enough is postpartum partners and their need to be educated about intrusive thoughts too. Oftentimes when a mom's feeling brave enough, she's telling her partner, like the partner is generally speaking, the first person that she goes to when she's talking about, like, hey, I'm having these really scary thoughts. And if the partner freaks out or tries to take the baby away or suggests that she's dangerous, it is absolutely devastating for her. So, partners, we have to help them understand that intrusive thoughts are common. Like having these thoughts don't mean she's gonna act out on them. The fact that she's distressed is a very good sign. She needs support, not judgment. And they can help by taking on more baby care and helping her reduce stress. Like they have this significant role they have to play in helping her make sure she's getting the support that she needs, that she's getting the nutrition, that she's getting the support, that she's getting, you know, the sleep. And I wish more providers would educate partners proactively about this rather than waiting for crisis. But again, it's like one extra thing on the list of, you know, a hundred plus things to do. And it can, it can be really hard to do that. And I recognize that. But here's here's something else that's really important. When intrusive thoughts are addressed through this nervous system disregard. Regulation and regulation, and we're addressing the root causes rather than symptom suppression. Mothers actually build resilience. They learn to recognize when their nervous system is dysregulated. They understand the early warning signs. They know what their body needs. They develop tools for regulation. This doesn't just help with intrusive thoughts. It helps with overall stress management, relationship changes, parenting decisions, future pregnancies. So when we only treat the symptoms, we miss the opportunity to help mothers understand and work with their nervous systems in a way that benefits them long term. I have a story to share with you about my own experience as well. And this is going to change the conversation a little bit here. But after my second baby, I had significant intrusive thoughts. And so when I had this combined intrusive thoughts plus this anger, like I just snapped at any freaking moment. My my first instinct was like, this is normal. I'm just exhausted. I'm just exhausted. I'm so tired. I just need a break, right? Which is partly true. But it didn't go away. It didn't go away. It actually just got worse. And I thought, you know what? I need to start paying attention. I started noticing when they were worse, when I uh hadn't eaten, when I was really stressed or something was happening, or I had a bad night of sleep. And so I started tracking these patterns. After I ended up going to my provider, I got some lab work done. I had really high inflammator inflammation that was happening in my gut. My provider was like, you have to get off gluten. I got off gluten and within normally you have to be off gluten for about six to eight weeks to see the benefit. By week four, I didn't have any rage and I didn't have any intrusive thoughts anymore. It was gone. It was not in my system at all. That inflammation that my body was experiencing from the gluten was skyrocketing me and causing my body to act out in a way in which like the brains, my brain was just completely dysfunctional. And everything within my body was completely dysfunctional because of gluten, you all. And sometimes when I say that, people look at me like I'm crazy. But when you start looking at the biological connections, it's it makes so much sense. And that experience taught me so much about the connection between the nervous system, between food, inflammation, and intrusive thoughts. And this is why our perinatal mental health training takes such a different approach than traditional mental health education, because most trainings teach you to screen for intrusive thoughts, differentiate from psychosis, and then refer for treatment. And we teach all of that, but we also teach you to understand intrusive thoughts as a symptom within a larger system. We teach you to assess the whole picture, nervous system state, nutritional status, sleep patterns, trauma history, support systems. We teach you to recognize when intrusive thoughts are a sign that the body needs support versus when they're severe enough to require immediate psychiatric intervention. We teach you how to talk to mothers about intrusive thoughts in a way that's validating without being alarming or educational, without being dismissive. And we teach you how to integrate all of this into your specific scope of practice. So whether you're a doula, a lactation consultant, a therapist, a nutritionist, or any other postpartum provider, one of the most powerful things you can do as a provider is help moms reframe what intrusive thoughts mean. So instead of I'm a terrible mother for having these thoughts or something is so wrong with me, we can help them understand your brain is trying to keep your baby safe and it's working overtime because your nervous system needs support. So I need to make these thoughts stop. We we instead teach those thoughts are giving you information about what your body and your nervous system needs. How can we support that? This reframe reduces shame. It empowers mothers to take action on root causes and it helps them work with their bodies rather than against them. If you're a provider working with postpartum mothers, here's what I want you to take away. First, normalize intrusive thoughts in a meaningful way. Don't say, you know, they're normal. Explain why they happen neurologically. Help moms understand their brains are brilliant and oftentimes dysregulated because we're not getting the enough support that we need. And second, assess them comprehensively. Don't just screen for intrusive thoughts and refer. Look at the whole picture, the nervous system, the sleep, nutrition, trauma, support. And third, address these root causes. Help mothers understand that supporting their nervous system and bodies isn't just about feeling better. It's about creating the conditions for the brains to function optimally. And fourth, of course, know when to refer. Severe intrusive thoughts, postpartum OCD, or any concern about psychosis, that requires immediate psychiatric evaluation. But even then, the nervous system and nutritional support, all of that still matters. And fifth, let's educate partners and support people. They need to understand intrusive thoughts, aren't dangerous, and how they can help. What we're really talking about today is how modern postpartum care has failed to support the massive neurological transition that mothers are going through. We expect women to go through this most dramatic brain changes they'll ever experience while sleep deprived, nutritionally depleted, socially isolated, chronically stressed. And then we're surprised when normal brain function becomes dysfunctional. The intrusive thoughts are not the problem. They are a symptom of a system that's not getting what it needs to the moms who need it most. So when we start supporting mothers properly with adequate rest, proper nutrition, nervous system regulation, trauma processing, genuine social support, these intrusive thoughts often resolve naturally. This is the approach we teach in our training programs. This is what the postpartum restorative method is all about. Because mothers deserve to understand what's happening in their brains and their bodies. They deserve support that addresses root cause, not just symptom management. And they deserve providers who understand the brilliant complexity of the postpartum nervous system. Intrusive thoughts are terrifying for moms, but they don't have to be pathologized, pathologized as proof that something is deeply wrong. And when we understand them as a function of the hyper-viligent nervous system that's not getting adequate support, then we can intervene in ways that actually help mothers heal rather than just managing symptoms. That maternal brain is doing exactly what it is designed to do, it's protecting the baby at all costs. And our job as providers is to support that brain so we can so it can do its job without spiraling into dysfunction. Thank you so much for listening to this episode. If you want to learn more about how to assess and support moms experiencing intrusive thoughts, check out our perinatal mental health training at postpartum you.com slash mental health. And remember, when we heal mothers, we heal the world. And if you're ready to dig deeper, come join us on our newsletter where I share exclusive insights, resources, and the latest tools to help you make a lasting impact on postpartum health. Sign up at postpartum you the letteru.com, which is in the show notes. And if you found today's episode valuable, please leave a review to help us reach more providers like you. Together, we're building a future where mothers are fully supported and thriving.

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Maranda Bower

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