Postpartum psychosis... How does the medical system fail to diagnose and treat new mothers?

Following the Lindsay Clancy case, a number of women began speaking out about deficiencies in maternal mental health care. Dr. Estee Rollhaus tells how her experience surviving postpartum psychosis led her to help other mothers find support.

Esty Rolhaus was a new mother when she began experiencing what she now says was postpartum psychosis. “I felt like there was a conspiracy against me to take my children away from me because I was unfit to care for them,” she said. “I remember feeling like everyone was staring at me, and then I heard people saying insulting things about me, and I now realize that was a hallucination.”

The trial in 2023 of former Massachusetts midwife Clancy, whose jury was unable to reach a verdict on whether she was criminally responsible when she strangled her three children, slit her wrists and throat, then jumped from the second-story window of her suburban home, has sparked a national debate about maternal mental health and a medical system that many new mothers say failed them.

Perinatal health experts say awareness of mental health disorders, as well as access to their treatments, is inadequate during the months surrounding pregnancy and childbirth. “One in five women will experience a mood or anxiety disorder during the perinatal period,” explained Dr. Katherine Berndorf, co-founder and CEO of The Maternity Centre. “Between 75 and 80% of them will not be diagnosed or treated,” she added.

Esty noted that she begged for help, but the psychiatrist she was seeing didn't know enough about postpartum mental health to recommend appropriate treatment. After two visits to the emergency department, doctors finally told her husband that she needed to stay in the hospital.

After 11 days in the hospital, she told her story to a doctor who finally linked her problems to the postpartum experience, who then discharged her and referred her to a “maternity center.” Facilities of this type are rare in the United States, where mothers can take their babies with them while they receive perinatal treatment from maternal and child health experts.

Clancy's attorney said she sought care at a similar facility, but was removed from it the same day. She also sought care from a number of medical providers.

Experts explained that there is a need for more facilities of this type, and for the medical system to recognize these disorders so that insurance companies can cover the costs of treatment more comprehensively, in addition to more psychiatrists who specialize in reproductive health and are trained in these disorders.