The trial of Lindsay Clancy, a Massachusetts woman charged with murder for the strangulation deaths of her three children, has raised the issue of postpartum psychosis.
Her defense team says she was suffering from the mental illness when she killed 6-year-old Cora, 3-year-old Dawson and 8-month-old Callan, then jumped out of a window. Prosecutors, on the other hand, say she acted intentionally and rationally and should be held responsible for her children’s deaths.
No matter what the jury decides, the case has a lot of people thinking about postpartum psychosis and mothers’ mental health. That includes Connie Guille, M.D., a psychiatrist at MUSC Women’s Health. She leads the Division of Women’s Reproductive Behavioral Health at the Medical University of South Carolina.
Guille has concerns about how the public may view postpartum psychosis as Clancy’s trial plays out. “It is important to recognize that this case and presentation of postpartum illness is very rare. Postpartum psychosis occurs in 1 in 1,000 deliveries and is very unlikely to result in an infant or child’s death,” she said.
“A much larger and more pressing problem is that maternal mental health conditions are the leading cause of maternal deaths in the United States due to suicide and drug overdose. The significant morbidity and mortality associated with maternal mental health conditions such as mood, anxiety and substance use disorder are far more common than postpartum psychosis.
“What I hope the public takes away for this case is an awareness of maternal mental health conditions and how best to help mothers and fathers experiencing mental health concerns during this time.”
Postpartum psychosis: A psychiatric emergency
So what is postpartum psychosis? “The working etiology of postpartum psychosis is bipolar disorder, which can be the first presentation of this illness or an exacerbation of the underlying disorder,” Guille said.
“The typical presentation of postpartum psychosis is shortly following delivery - for example, one to four weeks postpartum, or sometimes later, people with this condition start to experience poor mood, irritability, anxiety and often insomnia, and most importantly, an alteration of consciousness that can present as disorientation, confusion, bizarre thoughts or beliefs and/or a disconnect from reality that is inconsistent with that person’s prior beliefs, culture or educational background.”
Guille said one of the things that can be very confusing for patients and family members is that the person can have periods of altered consciousness with disorganized thoughts, confusion and bizarre beliefs followed by periods of clear, organized and rational thought.
“It is similar to a delirium where there is a waxing and waning of consciousness. The lack of sleep and overall stress associated with the postpartum period can worsen many of these symptoms as well.
“If partners, family members or friends are witnessing these signs and symptoms, they should ensure the mom is brought to an emergency room for an urgent psychiatric evaluation. Treatment for postpartum psychosis includes starting lithium and managing acute symptoms with classes of medications such as benzodiazepines and antipsychotics as needed,” Guille said.
“The strongest predictor of postpartum psychosis is a prior history of postpartum psychosis, so preventive measures with close monitoring are important if there is a subsequent pregnancy. Other risk factors include a personal or family history of bipolar disorder.”
Other mental health disorders related to childbirth
Guille said when evaluating someone with postpartum psychosis, it is critical to differentiate these symptoms from postpartum obsessive-compulsive disorder, which commonly presents during the postpartum period.
“Postpartum OCD is characterized by unwanted, intrusive and distressing thoughts that are related to things that the mother would never want to do, such as kill herself or her child. Mothers with this condition are often reluctant to share these thoughts with their partner, family, friends or a health care provider because they are not consistent with what they really believe but can’t control the thoughts from occurring. If these symptoms are happening, it is important to seek help as treatments such as therapy and/or medications can alleviate these symptoms and suffering. “
Guille said the most common mental health conditions during pregnancy and the postpartum year are mood and other anxiety disorders like depression and generalized anxiety disorder. “Evidence-based treatments for these conditions, including therapy and medications, if needed, are available. A statewide perinatal psychiatry access program was launched in May 2022 and provides direct patient care to pregnant and postpartum women with any mental health and/or substance use disorder concerns as well as provider consultations and trainings. 843-792-MOMS.”
The federal Health Resources and Services Administration also has a Maternal Mental Health Hotline, 1-833-TLC-MAMA, that provides 24/7 access to mental health support via text and phone.
“The most important thing for moms to know about maternal mental health and substance use disorders is that they are not alone, they are not to blame and help is available," Guille said.
