By Ally Kayton, DNP, APRN, NNP-BC, RMHI, IHP2
Founder, Sage & Stone Holistic Counseling & Integrative Health

For more than two decades, I have cared for mothers and babies during some of the most vulnerable moments of their lives.

As a Neonatal Nurse Practitioner, I have stood beside incubators while mothers watched their newborns breathe with the help of machines. I have cared for critically ill and premature infants while their parents tried to process a birth experience that looked nothing like the one they had imagined.

I have watched mothers navigate fear, exhaustion, grief, guilt, uncertainty, and the enormous physical and emotional transition that follows childbirth.

And now, as a mental health clinician working with women through pregnancy, postpartum, birth trauma, NICU trauma, grief, and other life transitions, I see another side of that story.

We spend tremendous energy keeping babies safe.

We need to become equally committed to protecting the mental health of their mothers.

The tragedy involving Lindsay Clancy and her three children forces us to confront why.

Three Children at the Center of a Tragedy

On January 24, 2023, Cora, Dawson, and Callan Clancy lost their lives in their Massachusetts home.

Their mother, Lindsay Clancy, a labor and delivery nurse, was subsequently charged in connection with their deaths.

As the criminal case has moved forward, questions surrounding her psychiatric condition at the time of the deaths have become central to the legal proceedings. Her defense has argued that severe postpartum psychiatric illness, including postpartum psychosis, affected her criminal responsibility. Prosecutors have disputed the defense’s characterization of her mental state and have argued that her actions were deliberate.

Those questions belong in a courtroom, where evidence can be examined and legal responsibility determined.

This article is not an attempt to diagnose Lindsay Clancy through news reports, social media, or fragments of medical information available to the public.

Nor is it an attempt to excuse, condemn, or determine criminal responsibility.

Three children died.

Their lives deserve to remain at the center of this conversation.

But this tragedy also raises a question that extends far beyond one mother, one family, and one courtroom:

Do we truly understand how serious postpartum psychiatric illness can become—and have we built a healthcare system capable of recognizing and treating it before a family reaches a crisis?

Postpartum Psychosis: A Rare Emergency Hiding in Plain Sight

Most people have heard of postpartum depression.

Far fewer understand postpartum psychosis.

Postpartum psychosis occurs in approximately 1–2 of every 1,000 births (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b). It is rare, but its rarity is part of what makes recognition challenging.

The onset is often abrupt, most commonly occurring approximately 3–10 days after delivery. Although diagnostic criteria traditionally focus on onset during the first several weeks postpartum, cases may present later (Committee on Clinical Practice Guidelines—Obstetrics, 2023b).

Symptoms can also fluctuate.

A mother may appear relatively well during one part of the day and significantly different hours later.

That unpredictability matters because postpartum psychosis can escalate rapidly.

It is not simply severe postpartum depression.

It is a psychiatric emergency involving impaired reality testing and potentially profound changes in thinking, behavior, mood, sleep, judgment, and insight (Committee on Clinical Practice Guidelines—Obstetrics, 2023b).

Who Is Most at Risk?

Postpartum psychosis frequently occurs in association with bipolar I disorder and may present as a manic, depressive, or mixed episode with psychotic features (Committee on Clinical Practice Guidelines—Obstetrics, 2023b).

Among the strongest known risk factors are bipolar disorder, a previous episode of postpartum psychosis, and a family history of bipolar illness (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b).

For women with a history of postpartum psychosis or mania, recurrence risk is substantial. Evidence summarized in current clinical guidance estimates an overall relapse risk of approximately 31%, with considerably higher estimates among women with both bipolar disorder and a previous postpartum psychotic episode (Committee on Clinical Practice Guidelines—Obstetrics, 2023a).

This is why psychiatric history matters during prenatal care.

But there is an important—and perhaps counterintuitive—point:

Many women hospitalized with postpartum psychosis have no previously known psychiatric diagnosis (Committee on Clinical Practice Guidelines—Obstetrics, 2023b).

“No psychiatric history” does not mean “no risk.”

Families and clinicians still need to recognize abrupt changes when they occur.

What Does Postpartum Psychosis Look Like?

Symptoms may include agitation, delusions, disorganized thinking, bizarre or markedly changed behavior, auditory or visual hallucinations, severe mood disturbance, mania, and dramatic changes from a woman’s usual level of functioning (Committee on Clinical Practice Guidelines—Obstetrics, 2023b).

Severe sleep disruption may also be part of the clinical picture.

Insight is often limited or absent.

That means the mother herself may not recognize that anything is wrong.

She may believe what she is experiencing is real.

She may not understand why her family is concerned.

She may resist help because, from her perspective, she does not need it.

This is one reason partners and family members are so important.

Sometimes the first meaningful clinical observation is not:

“I think I’m experiencing psychosis.”

It is:

“She isn’t herself.”

Clinicians must also remember that psychosis in the postpartum period is not automatically postpartum psychosis. Medical conditions, delirium, medication effects, substance intoxication, or withdrawal may produce overlapping symptoms and require appropriate medical evaluation (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b).

When a Mother Doesn’t “Look Sick”

One of the most dangerous misconceptions surrounding mental illness is that we can always see it.

We cannot.

A person experiencing significant psychiatric illness may still have conversations.

She may shower.

She may smile.

She may answer questions appropriately during an appointment.

She may care for her children.

She may have periods when she appears completely like herself.

And postpartum life makes recognizing psychiatric deterioration particularly complicated.

Of course she isn’t sleeping.

She has a newborn.

Of course she is anxious.

She’s a new mother.

Of course she is emotional.

Her hormones are changing.

Sometimes those explanations are appropriate.

But sometimes they allow serious symptoms to hide in plain sight.

Severe or escalating insomnia. Dramatic changes in behavior. Confusion. Paranoia. Delusional beliefs. Hallucinations. Mania. Significant agitation. Disorganized behavior. A sudden departure from a woman’s usual functioning.

Those deserve attention.

Not next month.

Not at the routine postpartum visit.

Now.

Why Postpartum Psychosis Is an Emergency

The American College of Obstetricians and Gynecologists identifies postpartum psychosis as a psychiatric emergency requiring immediate assessment and treatment (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b).

Because of the potential risk of suicide, accidental harm, or harm to the infant, hospitalization is generally indicated when postpartum psychosis is present (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b).

Immediate management centers on safety, urgent psychiatric consultation or emergency mental health evaluation, appropriate medical assessment, and treatment of acute symptoms.

When acute psychosis is suspected, the mother should not simply be sent home to “rest” or left alone to manage the situation.

Safety planning must consider both mother and infant.

Family or partner observations are also clinically important. Because insight can be impaired, collateral history from someone who knows the mother well can help clinicians understand changes in sleep, behavior, functioning, beliefs, and symptoms that may not be apparent during a brief assessment (Committee on Clinical Practice Guidelines—Obstetrics, 2023b).

And when severe symptoms emerge, families should not be expected to determine the diagnosis themselves.

They simply need to recognize:

Something has changed, and we need help now.

The Most Important Distinction: Intrusive Thoughts Are Not Psychosis

This may be one of the most important messages we can give postpartum mothers.

Frightening thoughts involving a newborn can occur during the postpartum period, including among women without a psychiatric disorder.

Postpartum obsessive-compulsive disorder can also involve disturbing intrusive thoughts or images involving harm coming to the baby (Meltzer-Brody et al., 2024).

These thoughts can be terrifying.

But an intrusive thought is not the same as intent.

And it is not automatically psychosis.

In postpartum OCD, the thoughts are typically unwanted and inconsistent with the mother’s values. She recognizes them as distressing, often experiences tremendous anxiety about having them, retains insight, and may go to extraordinary lengths to prevent the feared event from occurring (Meltzer-Brody et al., 2024).

A mother might think:

Why would I even think that? What kind of mother thinks something like this?

She may check the baby repeatedly.

Avoid certain situations.

Ask someone else to perform particular caregiving tasks.

Or hide the thoughts completely because she is terrified someone will misunderstand what they mean.

Postpartum psychosis is different.

The mother may experience delusions or hallucinations as real. Judgment and insight may be impaired. The clinical picture may include severe insomnia, hyperactivity, racing thoughts, disorganization, or delirium-like features (Meltzer-Brody et al., 2024).

The distinction is not merely academic.

A mother who is horrified by an unwanted intrusive thought and fears harming her baby needs compassionate assessment and appropriate treatment—not an automatic assumption that she is dangerous.

A mother who has lost touch with reality and holds a fixed delusional belief involving herself or her baby needs emergency evaluation.

Conflating the two can drive women into silence.

And silence is exactly what we do not want.

Mothers need to be able to tell us what is happening inside their minds without fearing that disclosure itself makes them a bad mother.

Screening Is the Beginning—Not the Solution

I believe strongly in perinatal mental health screening.

But administering a questionnaire is not the same thing as providing mental health care.

A mother can complete a screening tool.

She can screen positive.

She can tell us she is struggling.

And then what?

Can she see a therapist this week?

Can she access a psychiatric provider who understands perinatal mental health?

Does her insurance cover that provider?

Can she arrange childcare?

Can she afford to miss work?

Does she have transportation?

If outpatient treatment is no longer appropriate, where does she go?

Does the emergency department recognize a postpartum psychiatric emergency?

Does her partner know which symptoms mean they should seek immediate care?

Does her obstetric provider know what her therapist is seeing?

Does her pediatric provider know what her psychiatrist is seeing?

Who is connecting the pieces?

Identification without access to treatment is not enough.

America Has a Mental Health Care Problem

This conversation extends far beyond postpartum psychosis.

Even among the much more common perinatal mood and anxiety disorders, access to treatment remains inadequate.

According to an American Psychiatric Association resource document addressing disparities in perinatal mental health, screening practices vary substantially, and no more than approximately one-quarter of women who screen positive for depression receive treatment (Arora et al., 2025).

Disparities are even greater among Black, Hispanic/Latina, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander patients (Arora et al., 2025).

The reasons are not simply individual reluctance to seek help.

They are structural.

Stigma.

Fear about treatment.

Insufficient clinician training.

Lack of clear treatment protocols.

Limited referral networks.

Shortages of mental health professionals.

Inadequate psychiatric consultation.

Insurance barriers.

Social determinants of health.

Implicit bias and discrimination within healthcare encounters (Arora et al., 2025).

The American Psychiatric Association’s analysis highlights persistent gaps across the pathway from screening and identification through access to treatment and symptom remission (Arora et al., 2025).

That should concern all of us.

Mental health cannot continue to exist as a separate tier of healthcare.

Mental health is health care.

We would never tell a postpartum woman experiencing severe hemorrhage to wait several weeks for an appointment.

We would not tell a mother showing signs of postpartum preeclampsia to practice self-care and see whether she feels better next month.

We recognize that those conditions can deteriorate rapidly.

Severe psychiatric illness can, too.

Mental health care should not be a privilege available primarily to people who can find the right provider, afford treatment, navigate insurance, arrange childcare, take time away from work, and continue advocating until someone listens.

We need more than awareness.

We need access.

Prevention Starts Before Delivery

For women at known high risk, conversations about postpartum psychosis should begin before the baby is born.

Current clinical guidance recommends assessing psychiatric history during obstetric care, particularly asking about bipolar disorder and previous postpartum psychosis (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b).

Women with known high-risk histories may benefit from coordinated planning involving obstetric and psychiatric clinicians before delivery.

For certain women at highest risk, lithium initiated immediately postpartum has the strongest preventive evidence, with treatment decisions requiring individualized psychiatric and obstetric management (Committee on Clinical Practice Guidelines—Obstetrics, 2023a).

Planning should also address practical issues that are sometimes underestimated—especially sleep.

Sleep is not a luxury during the postpartum period.

For women at high risk for mania or psychosis, protecting sleep can be an important part of the postpartum psychiatric plan (Committee on Clinical Practice Guidelines—Obstetrics, 2023a).

Who will help with nighttime care?

How will medication be managed?

Who knows the warning signs?

Who will notice if she stops sleeping?

Who does the family call if her behavior changes?

Where will she be evaluated?

Those questions are much easier to answer before a crisis begins.

What the NICU Has Taught Me About Mothers

For more than two decades, I have cared for critically ill and premature newborns as a Neonatal Nurse Practitioner.

The NICU teaches you to notice small changes.

A subtle change in respiratory effort matters.

A feeding pattern matters.

A temperature matters.

A heart rate matters.

When something changes, we investigate.

I wish we approached maternal mental health with the same vigilance.

I have watched mothers sit beside incubators for hours.

I have watched parents learn medical terminology they never wanted to know.

I have seen mothers separated from their newborns after complicated deliveries.

I have watched families celebrate milestones most people never have to think about.

I have cared for babies whose mothers were simultaneously recovering physically and emotionally from traumatic births.

Some mothers blame themselves.

Some are afraid to leave the bedside.

Some are afraid to bond because they are terrified their baby might die.

Some are grieving the birth experience they expected to have.

Some are struggling with anxiety, depression, trauma, or exhaustion.

And some appear completely composed.

The NICU has taught me something I now carry into my mental health work:

You cannot assess a mother’s wellbeing simply by looking at her.

Sometimes we ask:

“How are you doing?”

She says:

“I’m fine.”

And the conversation ends.

Sometimes we need to ask again.

How are you sleeping?

What happens when you try to sleep?

Are your thoughts frightening you?

Do your thoughts feel like your own?

Do you feel safe?

Do you feel that your baby is safe?

Do you feel like yourself?

Has your partner or family noticed that something has changed?

Those questions should not be reserved for mothers who already appear to be in crisis.

The Mother and Baby Are Not Separate Stories

Our healthcare system often treats childbirth as though maternal and infant health become separate after delivery.

The obstetric team cares for the mother.

The neonatal or pediatric team cares for the baby.

Mental health may exist somewhere else entirely.

But the mother and baby do not experience their lives in separate departments.

Maternal mental health affects the family system.

Infant illness affects maternal wellbeing.

Birth trauma matters.

NICU hospitalization matters.

Sleep matters.

Feeding matters.

Support matters.

This is why perinatal mental health cannot belong exclusively to psychiatry.

It belongs in obstetrics.

It belongs in primary care.

It belongs in pediatrics.

It belongs in the NICU.

It belongs wherever mothers and families receive care.

As clinicians, caring for the baby should include recognizing when the person sitting beside that baby’s crib may need care, too.

This Cannot Be Only a Women’s Issue

Maternal mental health is not solely the responsibility of mothers.

Partners need education.

Families need education.

Nurses need education.

Physicians and advanced practice clinicians need education.

Pediatric and neonatal providers need education.

Employers need to understand postpartum recovery.

Communities need accessible mental health resources.

Imagine if every family left the hospital knowing the warning signs of postpartum psychosis as clearly as they knew when to call the pediatrician for a newborn fever.

Imagine if every partner knew that a postpartum mother suddenly going without sleep while becoming unusually energetic, confused, paranoid, or dramatically unlike herself was not something to simply “keep an eye on.”

Imagine if saying:

“I don’t feel like myself.”

opened a door to care instead of beginning a search for it.

That is the system families deserve.

We Must Be Careful About What the Lindsay Clancy Story Does Not Mean

The deaths of Cora, Dawson, and Callan are horrifying.

But we cannot allow this tragedy to become the public image of postpartum mental illness.

The overwhelming majority of mothers experiencing postpartum depression, anxiety, OCD, or other perinatal mental health conditions do not harm their children.

A mother experiencing frightening intrusive thoughts is not automatically dangerous.

And even when we discuss postpartum psychosis, we must be careful not to portray mothers experiencing psychiatric illness as inherently violent.

Fear of judgment can keep women silent.

Fear of hospitalization can keep women silent.

Fear that someone will take their baby away can keep women silent.

Fear of being labeled an “unfit mother” can keep women silent.

We need to create a culture where a mother can say:

“I’m not okay.”

“I haven’t slept.”

“I’m having thoughts that scare me.”

“I don’t feel like myself.”

“Something is wrong.”

And hear:

“Thank you for telling me. We’re going to take this seriously.”

What Families Can Do

Families do not need to become psychiatric clinicians.

They need to know their loved one and recognize when something has dramatically changed.

Learn the warning signs of postpartum psychiatric illness before the baby arrives.

Tell prenatal clinicians about a personal or family history of bipolar disorder and any previous postpartum psychosis (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b).

For someone at high risk, develop a postpartum psychiatric plan before delivery.

Protect sleep and build realistic support around nighttime caregiving.

Pay attention to abrupt changes in sleep, behavior, mood, thinking, judgment, or functioning.

And when someone who knows the mother well says:

“This is not her.”

Listen.

You do not need to diagnose postpartum psychosis to recognize that someone needs urgent help.

Cora, Dawson, and Callan Deserve More Than a Headline

As the legal proceedings involving Lindsay Clancy continue, there will be arguments about intent, responsibility, psychiatric illness, treatment, medication, and what happened inside one family.

Those questions belong in the courtroom.

Outside the courtroom, we have another responsibility.

We can learn.

We can talk about postpartum psychosis without portraying mothers with mental illness as dangerous.

We can remember Cora, Dawson, and Callan without turning their deaths into entertainment.

We can discuss Lindsay’s reported mental health history without diagnosing her ourselves.

We can support mothers while protecting children.

We can hold compassion, prevention, safety, and accountability in the same conversation without pretending they are the same question.

And we can demand better from our healthcare system.

As a Neonatal Nurse Practitioner, I have spent more than two decades advocating for babies who cannot advocate for themselves.

As a mental health clinician, I now advocate for the mothers and families standing beside them, too.

Those roles are not separate for me.

They have taught me the same lesson:

Families need us to notice before the crisis.

Ask the second question.

Listen when someone says she doesn’t feel like herself.

Take profound changes in sleep seriously.

Know the difference between intrusive thoughts and psychosis.

Screen—but have somewhere for the patient to go after the screen.

Teach partners and families what to watch for.

Build mental health into maternal and infant healthcare instead of placing it on the sidelines.

And give mental health the same urgency, resources, compassion, and clinical attention we give physical health.

Because maternal mental health is family health.

And caring for the mother is part of caring for the baby.

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When to Seek Immediate Help

Postpartum psychosis is a psychiatric emergency (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b).

A postpartum person experiencing hallucinations, delusions, paranoia, severe confusion, dramatically abnormal or disorganized behavior, significant loss of contact with reality, or another acute psychiatric change requires urgent medical and psychiatric evaluation.

Any concern about imminent suicide, harm to an infant, harm to another person, or inability to maintain immediate safety requires emergency intervention.

Families should not wait for a routine postpartum or mental health appointment when these symptoms are present.

Mental Health & Postpartum Support Resources

Postpartum Support International (PSI) HelpLine
Call: 1-800-944-4773 (4PPD)
Press 1 for Spanish or 2 for English
Text in English: 800-944-4773
Text in Spanish: 971-203-7773

The PSI HelpLine provides support, information, and connection to perinatal mental health resources. It is not an emergency crisis line. A trained volunteer returns calls or texts after a confidential message is left. (Postpartum Support International (PSI))

National Maternal Mental Health Hotline
Call or text: 1-833-TLC-MAMA (1-833-852-6262)

This national hotline provides free, confidential support 24 hours a day, 7 days a week for pregnant people, new mothers, and their families. Professional counselors can provide immediate emotional support and connect callers with additional mental health resources and care. (MCHB)

988 Suicide & Crisis Lifeline
Call: 988
Text: 988

The 988 Suicide & Crisis Lifeline is available for anyone in the United States experiencing a suicidal crisis or other emotional distress and provides crisis counseling and connection to additional support.

If there is an immediate threat to the safety of a mother, baby, or another person, or someone is experiencing severe psychosis or another medical or psychiatric emergency, seek immediate emergency medical care.

Asking for help is not a failure of motherhood. Mental health care is health care—and families deserve support before a crisis becomes a tragedy.

Postpartum psychosis is a psychiatric emergency (Committee on Clinical Practice Guidelines—Obstetrics, 2023a, 2023b).

A postpartum person experiencing hallucinations, delusions, paranoia, severe confusion, dramatically abnormal or disorganized behavior, significant loss of contact with reality, or another acute psychiatric change requires urgent medical and psychiatric evaluation.

Any concern about imminent suicide, harm to an infant, harm to another person, or inability to maintain immediate safety requires emergency intervention.

Families should not wait for a routine postpartum or mental health appointment when these symptoms are present.

For non-emergency perinatal mental health support, Postpartum Support International and the U.S. National Maternal Mental Health Hotline provide resources for pregnant and postpartum individuals and their families.

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A Note About the Lindsay Clancy Case

This article is intended for education and awareness. It does not diagnose Lindsay Clancy or offer an opinion regarding her criminal responsibility.

Statements regarding her psychiatric condition represent publicly reported claims, clinical evidence presented during legal proceedings, or arguments made by the parties involved in the case. Legal proceedings were ongoing at the time this article was prepared.

The scientific information regarding postpartum psychosis in this article is based on clinical literature and professional guidelines and should be considered separately from the legal determination in any individual case.

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References

Arora, G., Berry, U., Blaisdell-Brennan, H., Byatt, N., Gupta, A., Hammond, C., Hobbs, J. A., Montano, P., Payne, J., Simeon-Thompson, L., Wei, C., Warshaw, C., Woods, R., & Zeshan, M. (2025). Resource document on health disparities in perinatal mental health. American Psychiatric Association.

Committee on Clinical Practice Guidelines—Obstetrics. (2023a). Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstetrics & Gynecology, 141(6), 1232–1261. https://doi.org/10.1097/AOG.0000000000005200

Committee on Clinical Practice Guidelines—Obstetrics. (2023b). Treatment and management of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 5. Obstetrics & Gynecology, 141(6), 1262–1288. https://doi.org/10.1097/AOG.0000000000005202

Meltzer-Brody, S., Cohen, L. S., & Miller, E. S. (2024). Case 24-2024: A 30-year-old woman with postpartum anxiety and intrusive thoughts. The New England Journal of Medicine, 391(6), 550–557. https://doi.org/10.1056/NEJMcpc2312735