Op-Ed: The Conversation We Should Be Having About Perinatal Mental Health
By Dr. Becky Spencer
Once again, a high-visibility trial has forced perinatal mental health into the national spotlight, as the case of a Massachusetts woman accused of first-degree murder in the deaths of her three children hinges on her plea of not guilty by reason of insanity due to postpartum psychosis.
While the case of Lindsay Clancy has taken center stage in the media, it is important to remember that such tragedies are rare even if the number of women affected by perinatal mood and anxiety disorders are, unfortunately, all too common. It is also vital that we not paint all women struggling with postpartum disorders with the same, broad brush of “unsafe mother.”
As a psychiatric nurse practitioner specializing in reproductive mental health, I have cared for many women during pregnancy and the postpartum period. Perinatal mood and anxiety disorders are, in fact, among the most common complications of pregnancy and childbirth, affecting approximately 1 in 5 women. By comparison, postpartum psychosis affects only 1 to 2 women per 1,000 births, and it is one of the few true psychiatric emergencies in medicine.
One of the greatest public misconceptions is that all psychiatric conditions occurring after childbirth are simply “postpartum depression.” Perinatal mood and anxiety disorders, in fact, include postpartum depression, anxiety, obsessive-compulsive disorder, bipolar disorder, and postpartum psychosis — each with distinct symptoms, levels of severity, associated risks, and treatment approaches. Conflating these conditions not only obscures important clinical differences but also discourages women from seeking help for fear they will be judged.
The overwhelming majority of women experiencing postpartum depression, anxiety, or obsessive-compulsive disorder never harm their children. In fact, mothers with postpartum OCD are often frightened by unwanted thoughts or mental images of harming their baby precisely because those thoughts are inconsistent with who they are and what they value. Without education, many suffer in silence rather than disclose these symptoms and receive effective treatment.
By contrast, postpartum psychosis and bipolar disorder with psychosis are rare but serious illnesses. They are psychiatric emergencies that require immediate medical evaluation and treatment because they can impair a person’s ability to perceive reality, think clearly, and make sound decisions. Although uncommon, these illnesses carry a substantially higher risk of suicide and, in rare cases, infanticide when not promptly recognized and properly treated.
Another misconception is that severe psychiatric illness is always obvious. It is not. Many individuals continue to care for their families, meet responsibilities, and appear capable while living with a severe psychiatric illness. Mental illness does not always announce itself in visible ways.
Rather than increasing suspicion toward mothers struggling with postpartum mental illness, this case should prompt greater investment in specialized perinatal mental health care, universal screening throughout pregnancy and the first postpartum year, improved education for healthcare professionals and families, and timely access to evidence-informed treatment.
Whatever verdict ultimately emerges from the courtroom, one truth remains beyond dispute: replacing fear and misunderstanding with knowledge and evidence-informed care is one of the most powerful ways we can protect mothers, children, and families. This is the conversation we should be having about perinatal mental health.
By Becky Spencer, PhD, APRN, PMHNP-BC, IBCLC, FILCA, FAAN. Spencer is a psychiatric mental health nurse practitioner and owner of Blooming Beginnings Mental Health, PLLC, where she specializes in psychiatric treatment of women experiencing mental health challenges in the perinatal period. She has advanced certificates in reproductive psychiatry from The Center for Women’s Mental Health at Massachusetts General Hospital and the National Curriculum for Reproductive Psychiatry. She has also authored over 25 peer-reviewed publications, is the author/editor of two textbooks, and is an adjunct professor at Texas Woman’s University. Becky is a member of the Texas Nurse Practitioner Association.