Infant Journal
for neonatal and paediatric healthcare professionals

Unwanted intrusive thoughts in the context of neonatal care: coping with the ‘what ifs?’

As neonatal psychological professionals, we are hearing of increased levels of intrusive thoughts of harm in both neonatal staff and parents since the Lucy Letby trial. This increase makes sense in light of what we know about the experience of intrusive thoughts. Understandably, these thoughts can lead to high levels of anxiety and can start to undermine confidence and trust in ourselves and others. This paper aims to help colleagues understand what these thoughts are, how they arise, normalise experiencing them and reduce anxiety about their relationship to actual harm.

Fiona L. Challacombe
Lecturer in Perinatal Clinical Psychology, King’s College London, in conjunction with the Neonatal Leads for Psychological Practice (NeoLeaP; TABLE 1)

Challacombe F.L., Chilvers R., Butterworth R., Atkins E., Barr K., Cole S., Cordwell J., D’Urso A., Evans D., Higgins S., Marsh A. Unwanted intrusive thoughts in the context of neonatal care: coping with the ‘what ifs?’ Infant 2024;20(1):16-19.

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neonatal unit; perinatal; intrusive thoughts; healthcare professionals; anxiety
Key points
  1. Intrusive thoughts of infants being harmed are common in new parents and in healthcare professionals.
  2. Thoughts can be about accidental or deliberate harm by self or others.
  3. People feel distress about intrusive thoughts that they do not want to happen and will not act on.
  4. Reducing threat in the environment and responding compassionately to these experiences will help to reduce the impact of intrusive thoughts and prevent them interfering in the care of the infant.

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Administering the Hospital Anxiety and Depression Scale within a neonatal unit
Within recent years there has been an emphasis on developing effective psychological screening for mothers within postnatal mental health services. This study builds upon a previous pilot study that introduced psychological assessment skills training to community midwives. Following this training, a local standard was implemented, requiring the Hospital Anxiety and Depression Scale (HADS) to be administered at day two following birth, and then every ten days after this. The current study assesses the experiences of neonatal unit staff administering the HADS five years on.