The trial of Lindsay Clancy, the Massachusetts mother accused of killing
her three young children, has drawn intense attention and one haunting
question: How could a mother do something so horrific?
Some condemn her. Others see a profoundly ill woman. Still others blame
her treatment, pointing to the many psychiatric medications she received. But a
medication list cannot explain a tragedy. It reflects severity of illness,
diagnostic uncertainty and efforts to find effective treatment. It may also
demonstrate a weakness in our healthcare system. When a seriously ill patient
moves among multiple clinicians without adequate communication and care
coordination, the larger picture can be lost.
Fortunately, tragedies like this are extremely rare, but mental health
problems during pregnancy and after childbirth are common. Recognizing them
early can be lifesaving.
When Motherhood Becomes Overwhelming
Childbirth brings enormous physical and emotional changes. Recovery,
hormonal shifts, feedings, a crying baby, new responsibilities, and relentless
sleep deprivation can overwhelm even a well-prepared mother.
This is where families matter. Saying, “You need to rest,” is not enough.
Take the baby. Make dinner. Help with the other children. Give her several
uninterrupted hours of sleep. Practical help is often more valuable than
advice.
Baby Blues, Depression, and Anxiety
In the first days after childbirth, many women become tearful, irritable,
or anxious. These “baby blues” affect up to 80 percent of new mothers
and usually resolve within two weeks.
When sadness, anxiety, insomnia, and inability to function persist, it
may indicate postpartum depression. It affects roughly one in seven
women and often begins during pregnancy. A woman may lose interest in life,
struggle to concentrate, and experience changes in sleep and appetite. Severe
depression may bring thoughts of death or suicide. Waiting for improvement can
then be dangerous.
Significant anxiety affects roughly one in five women. A mother
may repeatedly check whether her baby is breathing, fear leaving the child even
with someone she trusts, or stay awake despite exhaustion to keep watch.
Some women experience frightening intrusive thoughts: “What if I hurt my
baby?” These thoughts are unwanted and terrifying precisely because the mother
does not want to act on them.
When Reality Slips Away
Postpartum psychosis is rare but
far more dangerous. A woman may lose the ability to distinguish a frightening
thought from reality, becoming severely confused, suspicious, agitated, or
experiencing delusions or hallucinations.
It affects only one or two women per 1,000 births but can develop rapidly.
It is strongly associated with bipolar disorder, and women with a previous
episode face a high risk of recurrence, making preventive planning during
pregnancy essential.
Postpartum psychosis is a medical emergency and requires immediate
treatment.
What Families Need to Understand
Over 30 years of practice, I have seen how families' attitudes affect
outcomes. “Pull yourself together.” “We all had babies.” “You have a beautiful
child—what could you possibly be unhappy about?” Such comments may be intended
as encouragement but can leave a woman ashamed and less likely to seek help.
Instead, ask, “What can I do to help?” Let her sleep. Take over some
responsibilities. Monitor her well-being. Families are often the first to
recognize when ordinary exhaustion has become something more serious.
Recovery Is Within Reach
Mental health conditions during pregnancy and after childbirth are highly
treatable. Milder problems may improve with support, sleep, and psychotherapy;
more serious illness may require medication. Pregnancy and breastfeeding do not
preclude psychiatric treatment. Treatment should balance benefits to the mother
with potential risks to the baby, recognizing that untreated illness also
carries risks.
The earlier illness is recognized and treated, the greater the chance of
full recovery.
A mother’s well-being is essential to the health and well-being of her baby and the entire family.
Professor of Clinical Medicine and Psychiatry, NYU Long Island School of Medicine (New York, USA).
Chair of Psychiatry, NYU Langone Hospital—Long Island.
