Understanding Perinatal Mental Health: What We Can Learn From the Lindsay Clancy Case

Before I begin, I want to acknowledge the tragedy at the center of this case, three children lost their lives, and a family has been shattered in a way that no diagnosis, verdict, or headline can erase. The sheer level of grief that this family has experienced is forever life altering. My hope is that by talking about perinatal mental health, we can collectivity show up better for new moms and support them, without judgement or criticism.

Cases like this one tend to get reduced down into a headline that erases the medical reality underneath it. Minimizing true mental health concerns can deepen the stigma around perinatal mental illness and makes struggling mothers less likely to disclose what they're experiencing, out of fear of judgment or of having their children taken from them.

Recognizing postpartum mental illness as a medical crisis doesn't erase accountability or minimize loss. It simply insists that we look at the whole picture, because the only way to prevent another tragedy like this is to catch the warning signs earlier, not to look away from them.

If you are currently suffering from any mental health concern, please reach out to a professional for help. Therapists and physicians are here to help.

Pregnacy & Postpartum Hormones & Biological Stressers

Women experience significant biological and physiological changes throughout the proceess of trying to conceive, pregnancy and after giving birth. Our bodies go from being our own to sharing space with a human(s) who are completlely dependant on us for survival.

As a mom of three, and as a therapist who works with women every single day, it is still hard to put into words the drastic shift that takes place in a women’s body during the perinatal period.

During pregnancy, several hormones shift dramatically to support gestation, and their sharp postpartum decline is directly implicated in mood dysregulation.

Estrogen rises to levels 10 to 100 times higher than a typical menstrual cycle by the third trimester. Estrogen supports serotonin synthesis and receptor sensitivity, meaning it plays a direct role in maintaining stable mood throughout pregnancy. Within days of delivery, once the placenta is expelled, estrogen falls by up to 90 percent, one of the steepest hormonal drops the human body ever experiences, and that decline removes a significant support for serotonin function almost overnight.

Progesterone rises in parallel with estrogen across pregnancy and falls just as steeply after birth. Progesterone's mood-relevant effects run through its neuroactive metabolite, allopregnanolone, which builds up across pregnancy and positively modulates GABA-A receptors, the brain's primary inhibitory signaling system. This GABAergic activity has a calming, anxiolytic effect throughout pregnancy; research links GABAergic dysfunction, closely tied to disruption of the hypothalamic-pituitary-adrenal (HPA) axis, to the neuroendocrine dysregulation seen in both major depressive disorder and postpartum depression (Maguire, 2019). When progesterone and allopregnanolone drop after delivery, this stabilizing influence withdraws nearly as fast as it built up.

Oxytocin surges around delivery and continues to rise with breastfeeding, supporting bonding, milk letdown, and, under typical circumstances, a calming, pro-social effect.

Prolactin rises in tandem to drive milk production. Both hormones are essential to the transition into early motherhood, but they rise against a backdrop of estrogen and progesterone collapse, meaning the body is simultaneously building new hormonal systems while losing the ones that previously stabilized mood, all while healing physically from childbirth.

Sleep deprivation on top of this hormonal free fall can be extremely dysregulating and overwhelming. Newborns wake every two to three hours, and new mothers rarely get more than fragmented, interrupted sleep for weeks. Poor sleep quality and fatigue are among the strongest predictors of postpartum depression risk (Baattaiah et al., 2023), and postpartum insomnia has been linked to elevated inflammatory markers associated with both depression and anxiety in the early weeks after birth (Drozdowicz-Jastrzębska et al., 2023). Chronic sleep loss on its own impairs judgment, emotional regulation, and stress hormone response, even without a hormonal crash layered on top of it.

For some women, this convergence of hormonal withdrawal and sleep deprivation coincides with recovering from and processing a traumatic birth experience, a burden that research shows frequently compounds, rather than occurs independently of, the neuroendocrine vulnerability already present in the postpartum period.

Please know that perinatal mental illness is not a character flaw, a failure to bond, or a lack of love for the baby. It is a brain and body under extraordinary biological stress, often with almost no support system built around it.

Perinatal Mental Health Diagnosis’

Postpartum Depression

Postpartum depression can start during pregnancy or show up anytime in the baby's first year. It's more than feeling tired or weepy: CDC-published data show diagnosis rates climbing to nearly 1 in 5 new mothers, more than double the rate in 2010 (Robbins et al., 2023). 

Postpartum Depression can present as:

• Sadness, emptiness, or numbness that doesn't lift, even on good days

• Overwhelming guilt, or a constant feeling of failing as a parent

• Loss of interest in things you used to enjoy, including time with the baby

• Appetite or sleep changes that go beyond normal newborn disruption

• Trouble bonding with the baby, or feeling disconnected and going through the motions

• Thoughts of self-harm, or feeling like your family would be better off without you

Thoughts of self-harm are always a reason to reach out for help right away, not something to wait out.

Postpartum Anxiety

Postpartum anxiety doesn't get talked about as much as postpartum depression, but it affects roughly 1 in 8 new mothers worldwide (Feldman et al., 2025), and it often gets missed or written off as normal new-parent nerves. Postpartum anxiety can present as:

• Worry that won't turn off, often fixated on the baby's health or safety, that goes beyond normal new-parent caution and starts to feel constant or intrusive

• Racing thoughts, especially at night, that make it hard to fall or stay asleep

• Physical symptoms: a pounding heart, nausea, dizziness, shortness of breath, or a knot in the stomach that shows up even when nothing is visibly wrong

• Inability to rest even when the baby is finally asleep, lying awake scanning for danger

• Restlessness, edge-of-your-seat tension, or heightened irritability that feels out of character

• A need to control or check things repeatedly, like the monitor, the breathing, the locks, to quiet the anxiety, even briefly

Postpartum OCD

Postpartum OCD shows up as unwanted, disturbing thoughts about the baby being harmed, paired with behaviors meant to manage the anxiety those thoughts create. It affects somewhere between roughly 1 in 40 and 1 in 10 new mothers, more common than most people realize (Ferra et al., 2024; Salari et al., 2024). Symptoms of Postpartum OCD can look like:

• Intrusive, unwanted thoughts or images of the baby being harmed, often sudden and frightening

• A strong sense of horror or disgust at having the thought, not any desire to act on it

• Repeated checking: making sure the baby is breathing, the door is locked, the stove is off

• Avoiding situations that trigger the thoughts, like bathing the baby alone or being near stairs or knives

• Mental rituals: counting, praying, or replaying the thought to try to cancel it out

• A constant undercurrent of dread that doesn't match what's actually happening

One distinction: these thoughts are horrifying to the mother having them. That's very different from psychosis, where a person may act on false beliefs without that same distress or awareness that something is wrong.

Postpartum Psychosis

Postpartum psychosis is rare, affecting roughly 1 to 3 out of every 1,000 births (Raza & Raza, 2023), but it is a true psychiatric emergency. It typically begins within the first one to three weeks after delivery and can escalate quickly. Symptoms of Postpartum Psychosis can include:

• Severe insomnia: not sleeping even when there's a chance to

• Rapid mood swings or extreme agitation

• Confusion or disorientation, seeming unlike themselves

• Paranoia or suspicion that doesn't add up

• Delusions (false beliefs) or hallucinations (seeing or hearing things that aren't there)

• Talking or behaving in ways that don't track with reality

Postpartum psychosis is a psychiatric emergency. It requires immediate psychiatric evaluation and, in almost all cases, hospitalization. The risk of suicide and infanticide rises sharply during an untreated psychotic episode. This is never a wait-and-see situation.

How to Support Someone Who May Be Struggling

• Believe her. If she says she's having intrusive thoughts, feeling hopeless, or doesn't feel like herself, take it seriously instead of chalking it up to normal exhaustion.

• Ask directly. “Are you having thoughts of hurting yourself or the baby?” Direct questions don't plant the idea. They open a door that shame usually keeps shut.

• Don't wait to be asked for help. Offer to make the appointment, sit with her in the waiting room, or take an overnight shift with the baby so she can get real, uninterrupted sleep.

• Know the difference between exhaustion and an emergency. Confusion, refusal or inability to sleep, rapid speech, paranoia, or statements that don't track with reality are signs of possible psychosis. That's a 911 or emergency room situation, not a check-in-tomorrow situation.

• Support the whole system around her. Partners and grandparents carry their own stress and exhaustion too. Check in on them, not just the new mother.

The Support New Mothers Deserve, and Often Don't Get

Part of why perinatal mental health conditions go unrecognized is structural. Only about a quarter of private-sector workers in the United States have access to any paid family leave, and there is still no federal paid maternity leave. Thirteen states and Washington, D.C. have passed their own paid leave laws, but most families are on their own (Congressional Research Service, 2025). Compare that to many peer nations, which guarantee four to five months or more of paid leave. A national study of PRAMS data found that mothers in states with stronger paid family and medical leave policies had lower odds of postpartum depression symptoms, with the biggest gains among mothers covered by Medicaid (Perry et al., 2023).

We send mothers home 24 to 48 hours after birth, often without a single scheduled mental health check before the standard six-week visit, into a hormone crash, physical recovery, and total sleep deprivation, frequently with a partner who has to return to work within days. Given all of that, it's not surprising that rates of postpartum depression, anxiety, and OCD are as high as they are. The system isn't built to catch it early. That has to change, and until it does, the people around a new mother are often her earliest and best line of defense.

Where to Get Help

• Postpartum Support International (PSI) HelpLine: 1-800-944-4773. Call or text, available in English and Spanish, staffed 8am–11pm ET.

• National Maternal Mental Health Hotline: 1-833-TLC-MAMA (1-833-852-6262). Free, confidential, available 24/7 by call or text, with interpreter services in more than 60 languages.

• 988 Suicide & Crisis Lifeline: Call or text 988, available 24/7.

If you believe someone is experiencing psychosis or is in danger of harming themselves or their baby, call 911 or go to the nearest emergency room immediately. This is not something to wait on.

At Well Mind Body, supporting women and families through the perinatal period isn't a side specialty. It's core to how we work. If you or someone you love is pregnant, newly postpartum, or trying to make sense of what “not feeling like myself” means, we're here. You don't have to wait until things fall apart to reach out.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Baattaiah, B. A., Alharbi, M. D., Babteen, N. M., Al-Maqbool, H. M., Babgi, F. A., & Albatati, A. A. (2023). The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: An emphasis on maternal mental health. BMC Psychology, 11, Article 10. https://doi.org/10.1186/s40359-023-01043-3

Congressional Research Service. (2025). Paid family and medical leave in the United States (Report No. R44835). Congress.gov. https://www.congress.gov/crs-product/R44835

Drozdowicz-Jastrzębska, E., Mach, A., Skalski, M., Januszko, P., Jabiry-Zieniewicz, Z., Siwek, M., Wawrzyniak, Z. M., & Radziwoń-Zaleska, M. (2023). Depression, anxiety, insomnia and interleukins in the early postpartum period. Frontiers in Psychiatry, 14, Article 1266390. https://doi.org/10.3389/fpsyt.2023.1266390

Feldman, N., Hibara, A., Ye, J., Macaranas, A., Larkin, P., Hendrix, E., Aydinian, T., Mittal, L., Wiegartz, P., Silbersweig, D., & Liu, C. H. (2025). Postpartum anxiety: A state-of-the-art review. The Lancet Psychiatry, 12(12), 947–959. https://doi.org/10.1016/S2215-0366(25)00197-X

Ferra, I., Bragança, M., & Moreira, R. (2024). Exploring the clinical features of postpartum obsessive-compulsive disorder: A systematic review. European Journal of Psychiatry, 38(1). https://www.sciencedirect.com/science/article/abs/pii/S0213616323000459

Medscape. (2025). Make postpartum psychosis a distinct disorder in the DSM, expert panel says. https://www.medscape.com/viewarticle/make-postpartum-psychosis-distinct-disorder-dsm-expert-panel-2025a1000tue

Perry, M. F., Bui, L., Yee, L. M., & Feinglass, J. (2023). Association between state paid family and medical leave and breastfeeding, depression, and postpartum visits. Obstetrics & Gynecology. Advance online publication. https://pubmed.ncbi.nlm.nih.gov/37917931/

Raza, S. K., & Raza, S. (2023). Postpartum psychosis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544304/

Robbins, C. L., Ko, J. Y., D'Angelo, D. V., Salvesen von Essen, B., Bish, C. L., Kroelinger, C. D., Tevendale, H. D., Warner, L., & Barfield, W. (2023). Timing of postpartum depressive symptoms. Preventing Chronic Disease, 20, Article 230107. https://doi.org/10.5888/pcd20.230107

Salari, N., Sharifi, S., Hassanabadi, M., Babajani, F., Khazaie, H., & Mohammadi, M. (2024). Global prevalence of obsessive-compulsive disorder in pregnancy and postpartum: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 18. https://www.sciencedirect.com/science/article/pii/S266691532400132X

Baattaiah, B. A., Alharbi, M. D., Babteen, N. M., Al-Maqbool, H. M., Babgi, F. A., & Albatati, A. A. (2023). The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: An emphasis on maternal mental health. BMC Psychology, 11, 10. https://doi.org/10.1186/s40359-023-01043-3

Drozdowicz-Jastrzębska, E., Mach, A., Skalski, M., Januszko, P., Jabiry-Zieniewicz, Z., Siwek, M., Wawrzyniak, Z. M., & Radziwoń-Zaleska, M. (2023). Depression, anxiety, insomnia and interleukins in the early postpartum period. Frontiers in Psychiatry, 14, 1266390. https://doi.org/10.3389/fpsyt.2023.1266390

Maguire, J. (2019). Neuroactive steroids and GABAergic involvement in the neuroendocrine dysfunction associated with major depressive disorder and postpartum depression. Frontiers in Cellular Neuroscience, 13, 83. https://doi.org/10.3389/fncel.2019.00083