Dropping the Baby and Other Scary Thoughts, 2nd Edition
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Postpartum intrusive thoughts are more common than most new parents expect, and more treatable than most believe. This book exists because fear, shame, and avoidance keep too many parents suffering in silence. It explains what unwanted thoughts in parenthood actually are, why they happen, and what evidence-based strategies can help break the cycle.
Whether you are a new parent, an expectant parent, or a clinician who works in perinatal mental health, this is a resource grounded in clinical research and designed for practical use.
The second edition has been substantially updated. New case descriptions, expanded guidance on disclosure barriers and stigma, and revised treatment approaches make this edition more relevant and clinically complete than the first.
Book Details
Full title: Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Parenthood, 2nd Edition
Authors: Karen Kleiman, Amy Wenzel, Hilary Waller, Cara Mandel
Publisher: Routledge
Pages: 278
Format: Print, digital, audiobook
Subject: Perinatal mental health, postpartum OCD, cognitive behavioral therapy, perinatal anxiety
About the Book
Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Parenthood, 2nd Edition, is published by Routledge and co-authored by Karen Kleiman, Amy Wenzel, Hilary Waller, and Cara Mandel. The book is an evidence-based guide published by Routledge and runs 278 pages across print, digital, and audio formats.
Its core focus is the experience of intrusive and unwanted thoughts during the perinatal period, which includes pregnancy and the months following birth. The book explains the psychological mechanisms that drive these thoughts, the role of reassurance seeking and avoidance in maintaining distress, and how cognitive behavioral therapy can help parents and clinicians interrupt the patterns that keep fear in place.
The tone is direct and compassionate. Clinical concepts are explained in accessible language without being simplified to the point of losing accuracy. The book works for readers who are in distress and for clinicians who want a credible, well-structured resource to supplement their work with perinatal clients.
Who This Book Is For
This book was written for a wide audience working through the same difficult territory from different angles.
New and expectant parents who experience frightening thoughts about their baby or about themselves will find clear explanations, genuine reassurance grounded in research, and practical strategies that go beyond generic advice to "just relax."
Therapists, psychologists, and counselors working with perinatal clients will find case descriptions and clinical frameworks that translate directly into session work. The book complements existing CBT training rather than replacing it.
Perinatal mental health specialists, including psychiatrists, social workers, and counselors who focus specifically on pregnancy and postpartum care, will find the updated treatment content and clinician-facing sections especially useful.
OB/GYN teams, midwives, and nurses who encounter patients disclosing distressing thoughts during prenatal visits or postpartum checkups will gain context for understanding these disclosures and how to respond.
Partners and family members who want to understand what a loved one is experiencing, and how to provide support without reinforcing avoidance or shame, will also find the book accessible and informative.
What the Second Edition Covers
The second edition is a meaningful revision, not a cosmetic update. The authors added content reflecting current clinical thinking and ongoing research into perinatal mental health.
Key additions and revisions include:
Updated treatment approaches rooted in cognitive behavioral therapy, with specific attention to the role of cognitive distortions, feared consequences, and behavioral avoidance in maintaining intrusive thought cycles
New clinical case descriptions that illustrate how different presentations unfold in real treatment contexts, making the book more practical for clinicians
Expanded coverage of stigma and shame, including how cultural, social, and personal factors affect whether parents are willing to disclose intrusive thoughts to a provider or partner
Disclosure barrier guidance that addresses why many parents choose silence, and what clinicians and support people can do to create conditions where honest disclosure becomes possible
Take-home strategies for both parents and mental health providers, formatted to support real-world use between sessions and outside clinical settings
Understanding Intrusive and Unwanted Thoughts in Parenthood
Intrusive thoughts during the perinatal period are thoughts that arrive without invitation and feel alarming, disturbing, or deeply out of character. They often involve feared harm coming to the baby, images of accidents or dangers, or thoughts about a parent's own ability to cope.
These thoughts are ego-dystonic. They feel foreign and wrong. Parents who experience them are typically horrified by them, not drawn to act on them.
This characteristic feature is what distinguishes intrusive thoughts from thoughts associated with postpartum psychosis, where disturbing cognitions may feel real, justified, or consistent with a person's beliefs.
Research consistently shows that postpartum OCD affects a meaningful number of new parents and that intrusive thoughts are present across a wide range of perinatal anxiety presentations. Checking behaviors, reassurance seeking, and avoidance of the baby or certain situations are common responses that temporarily reduce distress but strengthen the underlying thought patterns over time.
Shame and stigma make this worse. Many parents interpret intrusive thoughts as evidence of something wrong with them as a person or as a parent. The silence this creates prevents disclosure to partners, physicians, and therapists, which delays effective support and allows distress to build.
This book names these patterns clearly and explains them without judgment.
How CBT Addresses the Intrusive Thought Cycle
Cognitive behavioral therapy is the treatment approach the book draws on throughout. CBT targets the cognitive distortions, feared consequences, and behavioral responses that keep intrusive thought cycles active.
The central insight CBT offers for this presentation is that avoidance and reassurance seeking provide short-term relief but increase the frequency and intensity of intrusive thoughts over time. Every time a parent avoids holding the baby because of a frightening thought or asks a partner for the fifteenth time whether they are a bad person, the brain receives a signal that the thought represents a genuine threat. This is how distress becomes entrenched.
Exposure and response prevention (ERP) is one specific technique the book addresses, helping parents and clinicians understand how to approach feared situations gradually without relying on avoidance or reassurance. This approach requires clinical guidance, and the book provides a framework for how that guidance should unfold.
The evidence base for CBT in perinatal anxiety and perinatal OCD is well established. The book translates that evidence base into accessible language and concrete clinical tools. For additional clinical depth on cognitive behavioral treatment during the perinatal period, Cognitive Behavioral Therapy for Perinatal Distress offers a complementary treatment-focused resource.
Why Clinicians Use This Book
Clinicians who work with perinatal clients often encounter intrusive thought presentations without a clear, evidence-based resource to share with clients or to use in structuring their own case conceptualization.
This book fills that gap in several ways. The case descriptions provide realistic examples that translate into clinical discussion. The sections on stigma, disclosure barriers, and avoidance give clinicians language for conversations that clients often find difficult to start. The updated treatment framework helps practitioners integrate CBT-informed techniques into perinatal work, even if their training was in a more general context.
The book also works as a psychoeducational tool. Clinicians can recommend it to clients as between-session reading, use specific sections to introduce concepts, or draw on the case material to normalize the client's experience within a structured clinical framework.
For a broader clinical reference on the full landscape of perinatal psychology, The Oxford Handbook of Perinatal Psychology and The Routledge International Handbook of Perinatal Mental Health Disorders provide comprehensive academic coverage. For perinatal-specific anxiety treatment, Anxiety in Childbearing Women addresses overlapping presentations and treatment approaches. To browse all perinatal resources by Dr. Wenzel, browse all books on perinatal mental health.
Continue Exploring
If this book resonated with you as a new or expectant parent, the distress you are experiencing does not have to stay this complicated. Perinatal anxiety, postpartum OCD, and intrusive thoughts are treatable. The following resources address related concerns with the same evidence-based, clinically grounded approach:
Anxiety in Childbearing Women: a focused clinical resource on the full spectrum of anxiety presentations during pregnancy and postpartum
Cognitive Behavioral Therapy for Perinatal Distress: a treatment-oriented guide that walks through how CBT is applied in perinatal care
Coping with Infertility, Miscarriage, and Neonatal Loss: Finding Perspective: for those navigating grief and loss alongside or before the transition to parenthood
Tokens of Affection: addresses relationship strain and the emotional dynamics that can emerge during and after pregnancy
If you are a therapist or mental health professional looking to deepen your CBT practice, this book is one part of a broader body of work designed to make evidence-based therapy more nuanced, practical, and relationally sophisticated. Related professional resources include:
Innovations in Cognitive Behavioral Therapy: Strategic Interventions for Creative Practice: advanced techniques for clinicians who want to move beyond standard CBT protocols
Strategic Decision-Making in Cognitive Behavioral Therapy: a framework for navigating complex clinical decisions within a CBT model
Cognitive Behavioral Therapy Techniques and Strategies: a practical, technique-focused reference for direct clinical application
Therapeutic Relationship-Focused CBT: Dr. Wenzel's most recent contribution, integrating relational depth with evidence-based CBT structure
Evidence-Based Psychotherapy: Shared Decision-Making Toolkit for Mental Health Providers: a practical tool for involving clients in treatment planning using evidence-based frameworks
If you are a clinician seeking comprehensive reference material, the following encyclopedic and handbook resources provide authoritative coverage across clinical psychology and mood and anxiety disorders:
The Oxford Handbook of Perinatal Psychology: a comprehensive academic reference for researchers and clinicians working in the perinatal field
The Routledge International Handbook of Perinatal Mental Health Disorders: a broad, internationally oriented clinical reference covering the full range of perinatal mental health presentations
The SAGE Encyclopedia of Abnormal and Clinical Psychology: a multi-volume reference covering psychopathology, assessment, and treatment across clinical populations
SAGE Encyclopedia of Mood and Anxiety Disorders: a dedicated reference for clinicians and researchers working with mood and anxiety presentations
Handbook of Cognitive Behavioral Therapy: an overarching CBT reference covering theory, research, and application
If you are new to CBT or supervising trainees, these resources provide structured, accessible entry points into cognitive behavioral theory and practice:
Cognitive Behavioral Therapy for Beginners: An Experiential Learning Approach: designed for students and early-career clinicians building foundational CBT skills
Exploring Three Approaches to Psychotherapy: a comparative resource that situates CBT alongside other major therapeutic orientations
If your clinical work extends into specialized populations, the following titles address CBT applications in contexts that require adapted frameworks:
Cognitive Therapy for Suicidal Patients: a clinically rigorous guide to CBT-based suicide risk assessment and treatment
Cognitive Behavioral Therapy for Depressed Veterans and Military Service Members: CBT protocols adapted for military populations experiencing depression
Group Cognitive Therapy for Addictions: a structured guide for delivering CBT in group settings for substance-related presentations
To inquire about speaking, professional training, consultation, or clinical services, contact Dr. Amy Wenzel directly.
