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The country has been gripped by the horrific murder trial of Lindsay Clancy, a 35-year-old mother and former nurse accused of killing her three children before trying to kill herself. Her lawyers argue that she was suffering from postpartum psychosis, raising larger questions about maternal mental health and this lesser-known, but far more serious, perinatal mood disorder.
We sat down with perinatal psychiatrist Dr. Uruj Kamal Haider for a special edition of “Healthful” to talk more about mental health conditions, which are the leading underlying cause of maternal mortality. She explained that postpartum psychosis is “a break from reality” where “the brain cannot properly process information,” characterized by delusions, hallucinations and confusion. Dr. Haider said these delusions are “fixed false beliefs that tend to revolve around the baby.”
Postpartum psychosis is a psychiatric emergency where the mother must be sent to the hospital and the baby put into a safe place as soon as possible. But Dr. Haider emphasized that “with adequate and prompt treatment, most of these women go on to recover and have wonderful, beautiful lives with their family.”
We also had the chance to sit down with Kriti Lodha, a mom who bravely opened up about her own experience battling postpartum psychosis back in 2020. Lodha had no prior mental health condition, but she described “a perfect storm of sleep deprivation, being a new mom, a traumatic birth experience,” which she believes may have triggered her postpartum psychosis.
She said her daughter had trouble latching and started to lose weight. Soon after, Lodha said her first delusions revolved around the idea that she had postpartum depression and wasn’t able to care for her daughter. Ultimately, Lodha ended up calling 911 because, in her delusionary state, she believed neither she nor her husband was fit to care for their child.
From there, she was connected with an obstetrician who helped assess her condition. Lodha then went to the emergency room and was transferred a few days later to an inpatient psychiatric unit.
Now recovered, Lodha said: “I think it’s important to note that this is temporary. This is treatable. We know the pathways to care. And so timely treatment and diagnosis and treating mothers and babies with care and compassion really matters and makes a difference.”
Here are some of the major takeaways from our conversation:
The misnomer of “postpartum”
Dr. Haider explained that postpartum depression is a misnomer and should be considered more as perinatal depression or perinatal mood and anxiety disorders (which include OCD and anxiety). All of these disorders can present from conception up to a year after giving birth. The postpartum period is “one glimpse of time in that entire almost two-year time period,” she explained.
Psychosis: Rare but “potentially more lethal”
Perinatal depression is common: It presents in 1 in 7 people. Perinatal mood and anxiety disorders as a whole present in 1 in 5.
Postpartum psychosis is far less common, occurring in between one and two people out of every 1,000. But Dr. Haider said it’s “potentially more lethal” because postpartum psychosis carries a 4% risk of infanticide.
Look for the “pink flags”
“There’s a big myth that postpartum psychosis means that a mom is suddenly hallucinating that aliens are taking away her baby, or her voice is telling her to,” Dr. Haider said. “That is not always the case. And in fact, that is a smaller percentage.”
In reality, Dr. Haider said that postpartum psychosis is “a spectrum” with what she calls “pink flags” and “red flags.” It’s important for the community surrounding a mom to understand that they should be looking for the pink flags: earlier signs of psychosis.
One example: A mom who says she couldn’t sleep and was looking out the nursery room window all night because she was afraid someone would take her baby. Another: A mom who exhibits hypomanic behavior, characterized by unusually high energy and increased activity.
In Lodha’s case, she described going to her coffee shop and not being able to order, or needing help walking the dog. “I think there are so many things that slowly built up,” she said.
At the same time, Lodha said she felt very confident and attached to her baby. Dr. Haider reiterated the spectrum of psychosis: A mom can be high-functioning, capable of doing school pickup and drop-off, all while having these delusions inside her head.
“So my message, I think it’s simple, and I hope that we look for the pink before we ever see the red,” Dr. Haider said.
Two-thirds of perinatal mental health conditions start before the baby is born
While postpartum psychosis more commonly presents after the baby is born, most perinatal mental health disorders start before then. It’s why Dr. Haider says early detection of risk factors is so crucial.
The sooner mental health clinicians can start screening for risk factors — during family planning, IVF, before you’re even pregnant — the sooner they can identify women who may be at risk of maternal mental health conditions.
Lodha said it was really concerning to her that she had never heard of postpartum psychosis before she had it: “Like why didn’t people tell me about this? They told me about gestational diabetes. They told me about postpartum hemorrhage.”
She said she feels like “the healthcare system failed my family as much as it failed me.”
“I think we put so much onus and burden on mom or the birthing person to be the one to see the signs, whether it’s pink flags or red flags. I couldn’t. It needed to be someone I loved, or it needed to be my provider,” she said.
If you’re not satisfied with your level of care, get a second opinion
Dr. Haider urged patients and loved ones to ask for more time with your doctor or to get a second opinion if you’re not satisfied with the level of care you’re getting.
She also noted that a proper psychiatric assessment should not take less than 40 minutes to assess risk factors.
“The healthcare system, it’s fractured, and I don’t have a solution. But I think we have to acknowledge that,” she said. “I don’t want to scare families away about postpartum psychosis. I want to empower them. And I want them to know that we can identify risk factors. And, you know, you are allowed to seek the best care for you and your loved ones.”
