Postpartum Psychosis: Warning Signs Every Family Should Know

The ongoing Lindsay Clancy trial in Massachusetts has brought a rarely discussed maternal mental health condition into the national conversation: postpartum psychosis.

Clancy is on trial in connection with the deaths of her three children in 2023. Her defense has argued that she was experiencing severe mental illness, including postpartum psychosis, and was not criminally responsible for her actions. Prosecutors dispute that characterization and argue that her actions were deliberate.

It is not our place to diagnose Lindsay Clancy or determine what happened in her home. That is a question for medical experts and the court.

But her case raises a much larger question that every expecting and postpartum family should understand:

What is postpartum psychosis—and would you recognize the warning signs if they appeared in someone you love?

What Is Postpartum Psychosis?

Postpartum psychosis is a rare but extremely serious psychiatric condition that can occur after childbirth.

It is different from the "baby blues." It is also different from postpartum depression and postpartum anxiety.

A person experiencing postpartum psychosis can lose touch with reality.

Symptoms may include:

• Hallucinations—hearing, seeing, or experiencing things that aren't there

• Delusions or beliefs that aren't based in reality

• Paranoia

• Severe confusion or disorientation

• Disorganized or unusual behavior

• Extreme changes in mood

• Mania or unusually elevated energy

• Severe agitation

• Significant insomnia or a dramatically reduced need for sleep

  
  

One particularly important characteristic is that the person experiencing psychosis may not recognize that something is wrong.

That is part of what makes postpartum psychosis so dangerous.

Postpartum psychosis is a psychiatric emergency and requires immediate medical evaluation.

Postpartum Psychosis Is Not the Same as Postpartum Depression

The terms are sometimes used interchangeably in everyday conversation, but medically they are very different.

Postpartum depression may involve persistent sadness, hopelessness, loss of interest, guilt, difficulty bonding, changes in appetite or sleep, and thoughts of death or self-harm.

Postpartum psychosis involves a disruption in a person's perception of reality.

A mother experiencing postpartum depression generally understands what is happening around her, even while experiencing profound emotional distress.

Someone experiencing psychosis may hear a voice that isn't there, become convinced something terrible is happening when it isn't, develop unusual beliefs, or become confused about what is real.

Both deserve treatment.

Psychosis, however, requires immediate intervention.

Why Sleep Deserves Attention During the Postpartum Period

New parents are expected to be tired.

That expectation can sometimes make it difficult to recognize when sleeplessness has moved beyond ordinary newborn exhaustion.

A newborn waking every few hours naturally disrupts a parent's sleep. But severe or escalating insomnia—particularly when someone is unable to sleep even when given the opportunity—deserves attention when it occurs alongside significant changes in mood, thinking, behavior, or perception.

Sleep disruption is also particularly important in people who are vulnerable to bipolar-spectrum illness or postpartum psychosis.

This doesn't mean that lack of sleep alone causes postpartum psychosis.

And it certainly doesn't mean that every exhausted new mother is at risk of becoming psychotic.

It means dramatic changes in sleep can be one piece of a much larger clinical picture that shouldn't automatically be dismissed as "normal new-mom exhaustion."

Warning Signs Families Should Take Seriously

KNOW THE WARNING SIGNS

Postpartum psychosis is a psychiatric emergency. Seek immediate medical evaluation if a postpartum parent experiences:

• Hallucinations or hearing/seeing things others don't

• Delusions or beliefs that aren't based in reality

• Severe confusion or disorientation

• Paranoia or extreme suspiciousness

• Dramatic changes in mood or behavior

• Severe insomnia alongside changes in thinking or behavior

• Thoughts of harming herself, her baby, or someone else

Sometimes the people closest to a postpartum parent recognize that something has changed before the parent does.

A partner, grandparent, friend, nurse, or other support person might notice that she:

• Has barely slept for an extended period despite having opportunities to sleep

• Seems unusually confused or disconnected from reality

• Says she is hearing or seeing things others don't

• Develops beliefs that seem bizarre or impossible

• Becomes extremely suspicious or paranoid

• Is behaving dramatically differently from her usual personality

• Seems unusually energetic, agitated, impulsive, or unable to slow down

• Experiences rapidly changing or extreme moods

• Talks about harming herself or someone else

• Appears unable to safely care for herself or her baby

  
  

These are not symptoms to "watch for a few days" to see if they improve.

They require medical attention.

Postpartum Psychosis Does Not Make Someone a "Bad Mother"

This distinction matters.

Postpartum psychosis is a medical condition.

The overwhelming majority of parents experiencing postpartum mental health difficulties do not harm their children, and discussions of rare tragedies should never create the impression that postpartum depression or anxiety makes someone dangerous.

Stigma can actually make it harder for parents to disclose frightening thoughts or symptoms.

A mother may be afraid that saying, "Something doesn't feel right," will cause others to judge her ability to parent.

She needs to be able to say it.

And the people around her need to be willing to listen.

Sometimes the Family Has to Speak Up

One of the challenges of psychosis is that insight can be impaired.

That means the person experiencing it may genuinely believe that nothing is wrong—or may not be able to accurately describe what is happening.

Partners and family members therefore have an important role.

If someone you love has recently given birth and suddenly seems profoundly different, confused, paranoid, detached from reality, or is experiencing hallucinations or delusions, don't assume she simply needs a nap or a few hours away from the baby.

Tell healthcare professionals exactly what you are observing.

Be specific.

Instead of:

"She hasn't been herself."

Say:

"She has slept two hours in the last two days even though we've taken the baby so she can sleep."

Or:

"She told me she is hearing a voice that I cannot hear."

Clear descriptions can help clinicians understand the severity of what is happening.

When to Get Emergency Help

Postpartum psychosis requires immediate psychiatric evaluation and often hospitalization.

If a postpartum parent appears to be experiencing hallucinations, delusions, severe confusion, loss of contact with reality, or thoughts of harming herself or someone else, seek emergency medical care immediately.

Do not leave her alone with the baby while waiting for help.

This isn't a situation where a family needs to decide whether they are "overreacting."

Let qualified medical professionals make that determination.

Preparing for Postpartum Mental Health Before Delivery

We spend months preparing families to care for babies.

We should spend more time preparing families to recognize when a parent needs care, too.

Before delivery, expecting parents can talk with their OB/GYN or other healthcare provider about their mental health history and any factors that could increase their risk of serious postpartum mental illness.

Partners and close family members should also know what changes to watch for.

And families can make a postpartum support plan before the baby arrives.

That plan might include:

• Who will check in regularly during the first several weeks

• Who the family will call with mental health concerns

• How parents will get opportunities for uninterrupted sleep

• Who can help with meals, older children, household responsibilities, or newborn care

• What hospital or emergency service the family would use during a mental health crisis

  
  

You don't need to expect something to go wrong in order to prepare for the possibility that someone may need help.

Rest Is Important—But It Isn't Mental Health Treatment

At Postpartum Network, we talk frequently about the importance of sleep during postpartum recovery.

Our Registered Nurses provide overnight newborn care so parents have opportunities to rest while their baby's needs are cared for.

That support can be an important part of a family's overall postpartum plan.

But there is an important distinction:

Overnight newborn care is not treatment for postpartum depression, postpartum psychosis, bipolar disorder, or another psychiatric condition.

If one of our nurses—or a family member—recognizes symptoms that raise concern for a parent's safety or mental health, the appropriate response is escalation to qualified medical professionals.

Sometimes supporting a family means caring for their baby so they can sleep.

Sometimes it means recognizing that what we're seeing requires more than sleep.

We Need to Talk About Maternal Mental Health Before There's a Crisis

Cases like the Lindsay Clancy trial understandably generate enormous attention because the circumstances are devastating.

But postpartum mental health shouldn't only become a national conversation after tragedy.

We should be talking about it during pregnancy.

We should be teaching partners the warning signs.

We should be asking mothers how they're actually sleeping and feeling.

We should take significant changes in behavior seriously.

And when a mother says something is wrong, she deserves to be heard.

Most importantly, families should know that serious postpartum mental illness is treatable and recovery is possible with appropriate professional care.

At Postpartum Network, we believe postpartum care means supporting the whole family—not simply caring for the newborn.

Because caring for a new baby also means making sure the person who brought that baby into the world is being cared for, too.