This Isn't a True Crime Story. It's a Maternal Health Emergency.

A content note before we start: this piece discusses the deaths of children, postpartum psychosis, and maternal suicide attempt. If any of that feels like too much today, please close this tab ❤️

I’ve spent over 18 years in Emergency Medicine. I have seen women at the worst moment of their lives come through those ED doors, and there is almost always missed signals before the collapse. This Lindsay Clancy trial has been sitting heavy on my chest this week and it’s because I think her story was entirely preventable, and we are choosing, systemically, not to prevent it.

Here’s where things stand as I write this:

Lindsay Clancy is currently on trial in Plymouth Superior Court for the January 2023 deaths of her three children in their Duxbury, Massachusetts home. She has pleaded not guilty. Her defense is not arguing that she didn’t cause her children’s deaths, they are arguing she was not criminally responsible because she was in the grip of severe postpartum psychosis (compounded by what her attorney has characterized as over-medication). She attempted to take her own life that same night and is now paralyzed. Her ex-husband, Patrick Clancy, has testified for the prosecution about her deteriorating mental health in the months before. This trial is ongoing and there is no verdict yet. I’m not writing this piece to litigate her guilt or innocence, a jury is doing that, with far more information than any of us following from the outside will ever have.

I’m writing this because regardless of what that jury decides, the conditions that preceded this tragedy are not unique to this one family. These are the conditions we have built, nationally, for new mothers. And I think if this case becomes nothing more than true-crime content (if we consume it and move on) we will have wasted the one thing this case could actually do, force us to look at a system that is failing mothers in plain sight.

#1: Postpartum psychosis is a medical emergency, not a parenting failure

Postpartum psychosis is not the same thing as the “baby blues”, and it is not the same thing as postpartum depression, though it can emerge alongside either. It is rare, showing up in roughly 1 to 2 out of every 1,000 births. It is one of the few true psychiatric emergencies in all of medicine. It can include delusions, hallucinations, and a complete break from reality, and it typically comes on fast, often within the first two weeks postpartum. Women experiencing it are not “a little off.” They can be actively dangerous to themselves or their children while having no ability to recognize that danger in the moment.

And here is the part that should make every one of us furious: we have known this for decades. This is not new science. What is broken is not our understanding of postpartum psychosis. What is broken is the infrastructure meant to catch it before it becomes catastrophic.

Think about what actually happens after a woman gives birth in this country……

She is discharged from the hospital in 24 to 72 hours, handed a folder of pediatric follow-up appointments for the baby, and told to see her own OB in SIX WEEKS.

Six weeks.

An entire postpartum psychiatric emergency has a window to develop, escalate, and in the most devastating cases, end in tragedy, before anyone in the medical system is scheduled to check on the mother again.

#2: This is not a story about one unwell mother. It’s a story about a maternal health system with no support.

Let’s take a look at the actual infrastructure gaps:

There is no federal guarantee of paid parental leave in the United States. Zero.

We are one of a handful of countries on earth without one. A woman is expected back at work within weeks with zero income protection unless her employer chooses to offer it. Stress and exhaustion are not the cause of postpartum psychosis, but they are accelerants on every other underlying condition.

There is no standardized, mandated psychiatric follow-up for new mothers in most states. Screening for postpartum mood disorders (if it even exists at all) is often a single questionnaire handed to an exhausted woman in a pediatrician’s waiting room. There is usually zero private clinical time to actually explore any honest answer. Ask any mother you know if she has ever filled out one of those forms and how safe she felt writing down the truth on that form.

When medication is involved, we are talking about a psychiatric medication management system that is may be handled by an overextended OB or primary provider without psychiatric specialty training, adjusting doses over the phone, without the kind of close monitoring that psychiatric medication changes in a postpartum brain actually require.

These are not new critiques. Maternal health advocates, PMAD researchers, and postpartum support organizations have been screaming about every one of these gaps for years. What’s different about the Lindsay Clancy case is that it is forcing a national audience, many of whom have never thought about postpartum psychiatric care for even 5 minutes, to look directly at what happens when all of these gaps stack on top of each other.

#3: The reason these gaps exist and persist is not accidental. It’s what happens when a healthcare system is built by and for a default patient who was never a postpartum woman.

When you look at where our medical research dollars go, the pattern is not subtle.

We significantly under-fund maternal mental health research relative to its prevalence and severity. We treat the 6-week check as a box to check, not a real clinical evaluation. Our parental leave laws, insurance coverage, and disability protections were built around a male worker with a wife at home doing the unpaid domestic and reproductive labor. And even now, where maternity leave exists, employers often treat it as a courtesy instead of medical recovery time. We’ve never fully accepted that childbirth is a major medical event with a real recovery timeline, physically and psychiatrically.

This is about a system, built over generations, that consistently treats the mother as the caregiver and rarely as the patient. A system that will move mountains for a 5 day old’s pediatrician follow-up and offer a mother a single form in a waiting room.

#4: If this case is going to mean anything beyond a headline, it has to become policy pressure

So what would it actually look like to take this seriously?

• Universal postpartum mental health screening that happens more than once, administered by someone with the training and time to actually respond to a concerning answer

• A federal paid family leave standard - Not a patchwork of state policies and employer generosity.

• Expanded reproductive psychiatry training and reimbursement

• Mandatory, insurance-covered follow-up mental AND physical health visits in the first year postpartum. These visits should be built into standard perinatal care the same way we build in newborn pediatric visits.

• Public education on the difference between baby blues, postpartum depression, and postpartum psychosis, so that partners, family members, and mothers themselves know what an emergency actually looks like

• As a side note I do want to add the ability to go to a pelvic rehab physical therapist at least once postpartum (covered by insurance). So many women suffer from issues in their pelvis postpartum and should be evaluated.

None of this is radical.

Countries with better maternal mental health outcomes than ours have already built versions of this. We are not lacking a blueprint. We are lacking the political will to treat mothers as medically important.

If you are pregnant or postpartum and struggling, Postpartum Support International has a free helpline at 1-800-944-4773, with text support available. You are not alone in this, and asking for help is not a failure — it might be the thing that saves your life.

Understanding Postpartum Psychosis. TEDx Talk by Rachael Watters