Content note. This post discusses postpartum psychosis, suicide, and the deaths of children. Crisis resources are listed at the end. If you are in the postpartum period and find this kind of news frightening, it is completely reasonable to skip to the section titled “If the coverage itself is hard for you.”
For the past several weeks, a courtroom in Plymouth, Massachusetts has put perinatal mental health on the front page. Lindsay Clancy, a 35-year-old former labor and delivery nurse, is on trial for first-degree murder in the deaths of her three young children in January 2023. Her attorneys argue she should not be held criminally responsible because she was experiencing postpartum psychosis and had been improperly medicated. Prosecutors argue she understood what she was doing and acted deliberately. Much of the recent testimony has come from the psychiatrists and psychiatric nurse practitioners who treated her in the months beforehand.
We are not going to weigh in on the verdict. That question belongs to a jury that has heard evidence none of us watching from home have seen.
What we want to talk about is what this coverage is doing to the parents in our exam rooms.
Since the trial began, we have each had new mothers ask some version of the same question: “Could that be me?” Some have stopped telling anyone about their scary thoughts. A few have quietly stopped their medication. One said she was afraid that if she said the wrong thing out loud, someone would take her baby.
That is exactly the opposite of what needs to happen. So let’s talk about what postpartum psychosis actually is — and, just as importantly, what it isn’t.
What postpartum psychosis is
Postpartum psychosis is rare, occurring in roughly 1 to 2 of every 1,000 births (Osborne, 2018; VanderKruik et al., 2017). Onset is usually sudden, most often within the first two weeks after delivery, though it can occur later in the first year.
It is not an intensified version of postpartum depression. It is a distinct psychiatric emergency, and it typically looks like some combination of:
- Confusion, disorientation, or a “waxing and waning” quality where the person seems clear one hour and not the next
- Delusions — fixed beliefs that aren’t true, often involving the baby
- Hallucinations, including hearing voices
- Mania: racing thoughts, rapid speech, dramatically decreased need for sleep, unusual energy
- Severe mood swings, agitation, or paranoia
- Behavior that is clearly out of character to the people who know the person best
Two things about that list matter enormously. First, the symptoms fluctuate, which means a person can present as organized and reassuring during a 30-minute appointment and be profoundly unwell that same evening. Second, a large share of cases occur in people with no psychiatric history at all — among first-time mothers, close to half of reported cases involve no previous psychiatric hospitalization (Raza & Raza, 2023). Being “not the type” offers no protection.
Postpartum psychosis is also highly treatable when it is caught. With prompt psychiatric care — often inpatient — most people recover fully. The danger lies almost entirely in the delay.
The distinction that matters most: intrusive thoughts are not psychosis
This is the section we most want new parents to read.
Unwanted, intrusive, horrifying thoughts about harm coming to your baby are extremely common in the postpartum period. Estimates put the figure between 70% and 100% of new mothers, with as many as half reporting thoughts of harming the infant on purpose (Collardeau et al., 2019). Fathers report them too — one study found that 69% of new mothers and 58% of new fathers described unwanted intrusive thoughts about their infant (Abramowitz et al., 2003). They tend to arrive as a flash: an image of dropping the baby on the stairs, a thought about the knife in the drawer, a mental picture so awful it makes you feel sick.
If you are horrified by the thought, that horror is the clinically meaningful part.
Intrusive thoughts of this kind are ego-dystonic — they feel foreign and repugnant to the person having them, which is why they cause so much distress. They are a feature of anxiety and perinatal OCD, and the research to date does not find them associated with an increased risk of harming a child; a study designed specifically to test that question found no link between postpartum thoughts of infant-related harm and maternal aggression toward the infant (Fairbrother et al., 2022). What they typically produce is avoidance: a parent who won’t bathe the baby alone, won’t carry the baby downstairs, won’t be left alone in the house.
Psychosis is different in kind, not in degree. In psychosis, the belief feels true. It is not experienced as an unwanted intrusion to be resisted; it is experienced as reality, often accompanied by a rationale that makes internal sense to the person and no sense to anyone else.
If you have been silently terrified by your own thoughts since this trial started, please tell a provider. The parents who describe these thoughts in detail, with obvious distress, are describing anxiety — and anxiety responds very well to treatment.
Why this gets missed, and what the trial has surfaced
Whatever the jury decides, the testimony in this case has put a spotlight on failure points that perinatal providers have been describing for years. Among them:
- Fragmented prescribing. Court records in this case suggest more than a dozen psychiatric medications were prescribed across multiple providers in a matter of months. When no single clinician holds the whole picture, no one is positioned to notice a trajectory.
- Bipolar disorder that hasn’t been screened for. A history of bipolar disorder is the single strongest known risk factor for postpartum psychosis. Screening tools for postpartum depression are not designed to detect it, and starting an antidepressant without screening can, in some people, worsen agitation or trigger a manic episode.
- Sleep treated as a symptom rather than a warning light. In the postpartum period, everyone is exhausted. But a parent who is not sleeping even when given the opportunity — who is wide awake and energized while the baby sleeps — is showing a different sign than ordinary new-parent fatigue.
- Appointments that can’t see the whole person. A brief visit, in person or virtual, captures a slice. When symptoms fluctuate, collateral information from a partner or family member is often what reveals the pattern.
- A referral system with no rapid lane. Very few communities have a place a family can bring a frightened, deteriorating new parent at 9 p.m. on a Tuesday that isn’t a general emergency department.
None of this is a judgment of individual clinicians, who are working inside a system that was not built for this. It is an argument for building something better.
What to do if you are worried about someone right now
Treat suspected postpartum psychosis the way you would treat chest pain. Do not wait for the next available appointment.
- Do not leave the person alone with the baby, or alone at all, until they have been evaluated.
- Call their psychiatric or OB provider immediately and say the words “I think this is postpartum psychosis.” That phrase changes the urgency of the response.
- Go to the emergency department if you cannot reach anyone, or call 911 and say it is a psychiatric emergency involving a new mother.
- Call or text 988 for the Suicide & Crisis Lifeline, 24 hours a day.
- Call or text 1-800-944-4773 for the Postpartum Support International HelpLine, which can also connect families to perinatal-specialized providers.
Getting help is not the thing that separates a parent from their child. Untreated illness is.
If the coverage itself is hard for you
You are allowed to opt out of this news cycle. Mute the keywords. Leave the group chat thread. Ask your family not to bring it up. There is no clinical benefit to consuming coverage of a case like this while you are in the middle of the hardest year of your own life.
And if it has already gotten into your head — if you are lying awake auditing your own thoughts, or quietly wondering whether to stop your medication because a headline scared you — that is worth a phone call. Please do not stop a psychiatric medication on your own in the postpartum period. Talk to your prescriber first; there is almost always a safer path than an abrupt stop, including options compatible with breastfeeding.
What we would want every family to have
The care that prevents outcomes like the ones being described in that courtroom is not exotic. It looks like one provider who knows the whole medication history. Screening that asks about mania and psychosis, not just sadness. Someone who asks about sleep and takes the answer seriously. A partner or family member invited into the conversation. And a phone number that a frightened family can actually call.
That is the standard we should be demanding — not because of one case in Massachusetts, but because more than one in five people experience a perinatal mental health condition, and every one of them deserves care that would catch the rare emergency in time.
Care at Prestige Health & Wellness
If you are pregnant or in the first year postpartum and something feels wrong — with your mood, your sleep, your thoughts, or your sense of connection to your baby — we can help, and we will not be shocked by anything you tell us. Our team treats perinatal mood and anxiety disorders at both offices, and as an International Board-Certified Lactation Consultant, Ursula brings infant feeding into the same visit, so you are never asked to choose between the two. If you believe you may be experiencing postpartum psychosis, do not wait for an appointment: call 911, go to the nearest emergency department, or call or text 988.
Tampa: 813-252-0171 | Lakeland: 863-250-0240
Book online: https://yourprestigehealth.com
References and further reading
Osborne, L. M. (2018). Recognizing and managing postpartum psychosis: A clinical guide for obstetric providers. Obstetrics and Gynecology Clinics of North America, 45(3), 455–468. https://doi.org/10.1016/j.ogc.2018.04.005
VanderKruik, R., Barreix, M., Chou, D., Allen, T., Say, L., & Cohen, L. S. (2017). The global prevalence of postpartum psychosis: A systematic review. BMC Psychiatry, 17(1), 272. https://doi.org/10.1186/s12888-017-1427-7
Raza, S. K., & Raza, S. (2023). Postpartum psychosis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544304/
Fairbrother, N., Collardeau, F., Albert, A. Y. K., Challacombe, F. L., Thordarson, D. S., Woody, S. R., & Janssen, P. A. (2021). High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. Journal of Clinical Psychiatry, 82(2), 20m13398. https://doi.org/10.4088/JCP.20m13398
Fairbrother, N., Collardeau, F., Woody, S. R., Wolfe, D. A., & Fawcett, J. M. (2022). Postpartum thoughts of infant-related harm and obsessive-compulsive disorder: Relation to maternal physical aggression toward the infant. Journal of Clinical Psychiatry, 83(2), 21m14006. https://doi.org/10.4088/JCP.21m14006
Collardeau, F., Corbyn, B., Abramowitz, J., Janssen, P. A., Woody, S., & Fairbrother, N. (2019). Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: Study protocol. BMC Psychiatry, 19(1), 94. https://doi.org/10.1186/s12888-019-2067-x
Abramowitz, J. S., Schwartz, S. A., & Moore, K. M. (2003). Obsessional thoughts in postpartum females and their partners: Content, severity, and relationship with depression. Journal of Clinical Psychology in Medical Settings, 10(3), 157–164.
Postpartum Support International. Postpartum psychosis resources and HelpLine: https://www.postpartum.net
Trial coverage summarized from reporting by CBS Boston, CNN, PBS NewsHour, and The Boston Globe, July–August 2026.
