The Forgotten Fourth Trimester: Lindsay Clancy & The American Postpartum System 

Photo via The Patriot Ledger

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The first 12 weeks after birth, also known as the “The Fourth Trimester,” is an extremely vulnerable time for the mother. From endless days of swaddling and breastfeeding to sleepless nights, a period so pivotal for mothers is often the most overlooked when it comes to health.  

Experts from the Columbia University Irving Medical Center, including Dr. Mary Rosser, MD, PhD, and assistant professor of obstetrics and gynecology at the university’s Vagelos College of Physicians and Surgeons, argue that the fourth trimester “is often when mothers have the least interaction with their health care team.” Instead of focusing on the mother, who has just experienced the trauma of childbirth, all eyes shift towards caring for the newborn. 

Rosser emphasizes that only 40% of new mothers attend their postpartum follow-up visit– an appointment the American College of Obstetricians and Gynecologists highly recommends. These visits are crucial to supporting mothers and diagnosing illnesses such as postpartum depression and psychosis. When individuals opt out of these appointments, their likelihood of feeling supported by the healthcare system drastically falls. In fact, 40% of mothers reported not feeling heard or listened to by their healthcare providers, according to the Policy Center for Maternal Mental Health. Additionally, the CDC reports that 1 in 8 women were not asked about [depression] during a postpartum visit.

These statistics are indicative that new mothers are not receiving sufficient healthcare, as emphasis is put on the well-being of the infant. It presents a troubling reality of mothers nationwide and has unfortunately been illuminated during the highly contentious Lindsay Clancy vs. The Commonwealth of Massachusetts case that has been playing out in court for the past month.  

Clancy, a 36-year-old mother of three young children and a labor and delivery nurse, was indicted on three counts of murder and strangulation on September 15, 2023, in relation to the death of her children. Although Clancy has openly admitted to the charges, her lawyers argue that she experienced postpartum psychosis (PPP)– a “condition that affects a person’s sense of reality, causing hallucinations, delusions, paranoia, or other behavior changes. In severe cases, people with PPP may attempt to harm themselves or their newborn.” Her husband, Patrick Clancy, alongside members of her family, claimed Clancy experienced a “deterioration of her mental state in the months leading up to the killings of her three children, describing increasing paranoia, insomnia, and suicidal thoughts.”

The case, which has garnered international media attention, is not aiming to determine Ms. Clancy’s guilt, but rather aims to answer the question of whether, at the time of the murders, she was experiencing a psychotic episode that left her unable to fully understand the consequences of her actions. The trial has focused on whether the murder was premeditated, if her psychosis influenced her actions, and where she should ultimately end up–whether that be in a prison or mental health facility. Clancy has received overwhelming support throughout the trial, with individuals lining up around the perimeter of the courthouse in protest.

The case ended in a mistrial and added to the discourse surrounding postpartum care. Clancy’s case, which was not just a murder case that would be covered on the news or on podcasts, is, in fact, revealing the scary repercussions of current medical postpartum treatment. Before the murder, Clancy, “who was never formally diagnosed with postpartum psychosis before the killings, was given antidepressants and sleep medications that may have worsened her symptoms.” Many advocates of Clancy’s cause argue that postpartum clinicians consistently put the health of newborns on a pedestal and, in doing so, cast mothers down. The problem boils down not to whether the child’s or the mother’s life is more important, but to why the two lives seemingly don’t receive equal care. Hospitals and medical professionals caring for mothers, whether in or out of the “fourth trimester,” must remain vigilant. Lindsay Clancy’s case is evidently not an anomaly, and so many mothers across the nation joined in the uproar against the current state of the postpartum care system. The Clancy case itself cannot tell society what is wrong with postpartum care in America. But it can bring the argument to the limelight, allowing doctors and parents alike to confront a system in which mothers feel like they are not being seen, and as a result, are experiencing serious psychiatric symptoms and illnesses.

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This article was edited by Catherine Hart Sheehy and Emma Zadrima.