If you’ve had a baby, you’ve had postpartum.

And yet, say the word out loud and watch the room recoil: “Oh, I don’t have postpartum.” As if it were a condition reserved for someone else—someone visibly unwell.

In this episode, I sat down with perinatal therapist Eva Reichel to unpack what postpartum mental health actually encompasses. The conversation was sobering, clarifying, and—frankly—long overdue.

The thesis is simple: postpartum is not synonymous with depression. It is a biologically and psychologically vulnerable transition that can surface anxiety, OCD, PTSD, and more. And most women are not adequately screened.

Intrusive Thoughts in Postpartum: More Common Than You Think

When we asked our community about “taboo” postpartum experiences, one theme flooded our inbox: intrusive thoughts.

Not fleeting worries. Catastrophic, graphic, looping thoughts.

What if I drop the baby down the stairs? What if she stops breathing in the night? What if I swerve the car and we all die?

According to peer-reviewed research, Eva cites, 80–90% of new mothers experience intrusive thoughts in the perinatal period. For fathers, it’s around 60%.

This is not evidence you are unstable. It is evidence your brain is on high alert.

From an evolutionary standpoint, the brain is wired for protection. The problem is it can misfire. It overcorrects. The protective instinct becomes a false alarm system—loud, persistent, convincing.

The key distinction: intrusive thoughts are unwanted. They are distressing precisely because you love your child.

When Postpartum Anxiety Becomes Perinatal OCD

For some mothers, intrusive thoughts don’t fade. They escalate.

Perinatal OCD occurs when those thoughts begin driving compulsive behaviors:

• Avoiding stairs, driving, or baths
  

• Repeated reassurance-seeking (“Are you sure she’s breathing?”)
  

• Constant checking of monitors or vitals
  

• Ritualized “be safe” phrases before leaving the house
  

Avoidance feels logical. It feels responsible.

But avoidance feeds OCD.

Eva shared a striking statistic: a retrospective clinical study examined OCD diagnoses in women that experienced pregnancy and postpartum. The findings showed that 32% of women, about one-third, had no prior history of OCD before childbirth. The onset occurred postpartum.

Sleep deprivation. Hormonal shifts. Identity rupture. Heightened responsibility. All of it compounds vulnerability.

This is not rare. It is under-recognized.

Postpartum Depression Isn’t the Whole Story

The cultural narrative is narrow: we screen for depression at the six-week OB visit and call it comprehensive care.

It isn’t.

Postpartum mental health includes:

• Postpartum anxiety
  

• Perinatal OCD
  

• Birth-related PTSD
  

• Relationship strain
  

• In rare cases, postpartum psychosis (a medical emergency)
  

The standard Edinburgh Postnatal Depression Scale (EPDS) is brief and often framed poorly. Eva shared her own experience of being handed the form with, “You’re not depressed, right?”

That subtle cue is enough to silence honesty.

Anxiety in the perinatal period is often more prevalent than depression—yet far less discussed.

And six weeks is late.

The first two weeks may include “baby blues.” Anything persisting beyond that warrants deeper screening.

Intrusive Thoughts vs. Psychosis: Why Provider Training Matters

There is a critical clinical difference between OCD and psychosis.

• OCD: You are horrified by the thoughts. You do not want them.
  

• Psychosis: There is a break from reality.

Misdiagnosis can lead to unnecessary inpatient hospitalization—or missed care entirely.

Provider education matters. Pediatricians, who often see mothers sooner than OBs, can be pivotal in early intervention. A simple, sincere “Are you okay?” can change trajectory.

What Actually Helps With Postpartum OCD and Anxiety?

1. Name It

Label the thought: “This is an intrusive thought.” Naming creates space between you and the fear.

2. Resist the Compulsion

Notice the urge to check, avoid, or reassure.Pause before engaging. Even a few seconds counts.

3. Feel the Feelings

OCD convinces you that you have to 'fix' this feeling or thought that is uncomfortable. Learn to sit with it. Name the feeling and learn that you can feel anxious, fear, panic, and those feelings are uncomfortable, but not dangerous.  Any intense emotion, like anxiety, rises and falls, and we can learn to 'ride it out like a wave'. We can learn to work through them in a different, more helpful way. The less we rush to 'fix' the feeling or thought, the more likely we can break this vicious OCD cycle.

4. Lean into Uncertainty

When we accept living with some uncertainty, obsessions become less disturbing and compulsions lose their power.

5. Protect the Protectors

Sleep is protective.
Nutrition is protective.
Gentle movement is protective.
Fresh air is protective.

The brain under-fueled and under-slept is not a reliable narrator.
Prioritizing protein, omega-3s, and mineral replenishment in the early postpartum period can meaningfully support nervous system stability.

Postpartum Support: Start Before You Need It

“Build your village” sounds quaint until you’re leaking through a nursing bra at 3 a.m., crying over a baby monitor.

Practical support includes:

• Pre-arranged meal trains
  

• Someone to hold the baby while you nap
  

• Honest conversations about mental health risk
  

• A therapist lined up before crisis

And perhaps most radical: acknowledging that postpartum does not end at six weeks. Or one year.

Unaddressed symptoms can echo for a decade.

The Quiet Relief of Being Understood

One of the most resonant moments in our conversation was this:

There is no amount of reassurance that can fully extinguish uncertainty. Motherhood requires living with risk. OCD tries to eliminate it. That tension is exhausting.

But intrusive thoughts are common. Postpartum anxiety is treatable. And screening should be broader than a clipboard at six weeks.

If any of this feels familiar, you are not broken. You are likely biologically primed and perhaps unsupported.

We go much deeper into intrusive thoughts, postpartum OCD, birth trauma, and screening gaps in the full episode.

Watch the full YouTube conversation here.

 

If you want to hear more from Eva you can find her on LinkedIn and @cbtofcsfl