Karen Kleiman, founder of the Postpartum Stress Center and author of "This Isn’t What I Expected: Overcoming Postpartum Depression" says it all depends on how much what she calls "scary thoughts" interfere with a woman's daily life.
"It's normal to have scary thoughts," Kleiman told TODAY Parents. "Most new moms will admit to thinking, 'What if I drop the baby? What if I slip on the ice? What if I drop him in the tub?' but we consider those thoughts to be normal." Kleiman cites a study by clinical psychologist Jonathan Abramowitz indicating 91 percent of all new mothers admit to experiencing scary thoughts about harm coming to their babies.
On the opposite end of the spectrum are thoughts that are more distressing, gruesome, violent or chaotic than the average worry about dropping baby.
"The determining factor is how much distress it causes," said Kleiman. "If you or I are having a thought about, 'Oops, I could drop my baby,' we hold our baby tight and we go on with our day. But, if a mom starts obsessing about it — if she starts worrying about the thoughts, if it means she can't leave her room because of her 'what if?' worries — her distress is higher. And that's when we treat it, when the distress is so high that it's interfering with their functioning."
Kleiman says women who experience these kinds of thoughts are often ashamed or afraid to tell anyone what they're thinking, for fear of being deemed a bad mother.
It's because of this stigma that Kleiman and her colleagues started the #speakthesecret campaign — a website inviting mothers to share their scary thoughts anonymously.
"Once they break the silence in a place that feels safe, the anxiety reduces," said Kleiman. "When their anxiety reduces, then their scary thoughts reduce. So, there can be some healing that takes place by literally just putting it out there and seeing they are not the only one."
The site launched a little over one week ago, and already more than 100 women have anonymously confessed their scary thoughts about motherhood.
"After I had my second child, I imagined putting them both in my chest freezer so I could get some sleep," reads one anonymous confession. "That’s when I decided to get on meds."
"I had awful, intrusive thoughts of dropping my baby down the stairs," reads another. "So much so that I would hold him a little tighter every time I got near any stairs because I was so afraid of it actually happening."
Another admits, "I worry I’m not sane enough to be a good mother."
"This particular campaign has been started to say, 'Tell us how bad you feel,' because women are killing themselves," said Kleiman. "Scary things are happening. At best, they're not feeling good and they're struggling to feel like a good mother. And, at worst, they are dying."
A separate campaign, started by Kleiman and illustrator Molly McIntyre, features comics depicting what women say when they are experiencing postpartum depression or anxiety versus what they are actually thinking.
In one comic, a new mom is asked how she's doing and responds, "I'm fine," while thinking, "I'm sorry I had this baby," and "I don't even recognize myself."
In another, a new mom is asked if she feels like she's experiencing the "best time" of her life. While she answers, "Of course," her thoughts show her processing feelings like, "I think my baby would be better off with another mother."
"We live in a culture that doesn't make it easy to say these things out loud," said Kleiman, who hopes to continue the series of comics and combine them into a book for postpartum women. "Women are afraid to let other people know."
Kleiman hopes both campaigns will help women who are feeling anxious or depressed, or having scary thoughts, ask for help.
"They should let somebody they trust know — ideally their partner and a healthcare provider who has experience treating maternal mental health," said Kleiman. "Women carry around the shame and the pain that comes with these feelings, but they don't have to, and they are not alone."