Frequently Asked Questions

In this cohort, 9.2% of birthing parents reported 1 or more unwanted intrusive thoughts of infant-related sexual harm by the second postpartum interview (n = 38 of 414; 95% CI, 6.6%–12.4%). At the first postpartum interview, 6.1% reported these thoughts (n = 25 of 412; 95% CI, 4.0%–8.8). The interviews occurred on average at 9.1 weeks and 21.3 weeks postpartum.

No association was found between unwanted intrusive thoughts of infant-related sexual harm and self-reported sexual behavior toward the infant in the participants who provided both thought and behavior data. Among 330 participants with both datasets, only 1 reported touching their infant sexually, and that participant did not report sexual-harm intrusive thoughts. Fisher exact testing found no association (P = 1.00; 95% CI, −0.0003 to 0.009).

The most commonly reported thought from birth to the second postpartum interview was “touching your baby’s genitals in an inappropriate way,” reported by 8.5% of participants (n = 35; 95% CI, 6.0%–11.6%). Other reported thoughts were “being ‘turned on’ sexually by your baby” in 2.9% (n = 12; 95% CI, 1.5%–5.0%) and “touching your baby in a sexual way” in 1.7% (n = 7; 95% CI, 0.7%–3.5%).

In participants who completed both postpartum interviews, these thoughts were more often reported at only 1 time point than at both. Among 324 participants with complete data at both assessments, 4.8% reported infant-related sexual-harm intrusive thoughts at the early interview only (n = 16; 95% CI, 2.8%–7.7%), 2.5% at the late interview only (n = 8; 95% CI, 1.1%–4.8%), and 2.2% at both interviews (n = 7; 95% CI, 0.9%–4.4%).

No evidence suggested that longer follow-up explained who endorsed these thoughts. Participants who did and did not report infant-related sexual-harm intrusive thoughts had nearly identical follow-up timing at the later assessment: mean 21.21 weeks postpartum versus 21.31 weeks postpartum. Statistical testing found no association using either group comparison (z = −0.301, P = .763) or logistic regression (χ²1 = 0.03, P = .873).

Birthing parents who reported both physical-harm and sexual-harm intrusive thoughts described those thoughts as more time-consuming than parents who reported physical-harm intrusive thoughts only (z = −3.46, P < .001). However, the groups did not differ significantly in distress (P = .083) or impairment (P = .956). This comparison was between a PHYS + SEX group (n = 33) and a PHYS ONLY group (n = 138).

The study used a semistructured interview, the Postpartum Intrusions Interview, to assess unwanted intrusive thoughts of infant-related harm, including 3 sexual-harm items: “touching your baby’s genitals in an inappropriate way,” “being ‘turned on’ sexually by your baby,” and “touching your baby in a sexual way.” Infant-harming behavior was assessed with the anonymized 24-item Parenting Behaviours Questionnaire, which asked how often participants had engaged in behaviors including “You touched your baby in a sexual way” since birth. Obsessive-compulsive symptom severity was assessed with a modified Yale-Brown Obsessive Compulsive Scale focused on infant-related thoughts and responses.

The authors suggest that disclosure may increase when parents are asked with perinatal-specific thought lists and normalizing information. In this study, which used both, the period prevalence by the second postpartum interview was 9.2%, and the discussion notes that prior studies using similar methods reported estimates above 8.0%, whereas 2 studies without those features reported estimates below 5.0%. Based on the available literature, the authors state that postpartum intrusive thoughts of infant-related sexual harm likely fall between 8.0% and 12.0%.

The main limitation is that the sample was too small to rule out a relationship with complete confidence, because only 1 participant reported sexual behavior toward the infant. The authors also note possible underreporting of both intrusive thoughts and harming behaviors, incomplete follow-up, variable timing of postpartum assessments, and limited generalizability because the sample was fairly wealthy, well educated, and restricted to birthing parents in British Columbia. They conclude that larger and more diverse samples are needed to confirm the findings.