Lindsay Clancy welcomed her third child into the world on May 26, 2022.
Warning: This story contains details that may be distressing for some readers.
Then 32 years old, the Massachusetts mother had a reputation for being "sensible" and organised, someone who "rarely took a break", according to her husband Patrick Clancy.
But after the birth of her youngest, Callan, she started acting differently.
Her sister noted she impulsively joined a multi-level marketing scheme.
One week after the delivery, she began waking up at 4am daily, exercising for hours.
By the 12-week mark, according to a civil suit filed in Massachusetts Superior Court, she had become anxious and depressed.
She slept just three hours a day, and stopped exercising.
Her parents arrived to help care for Callan, and her older children, five-year-old Cora and three-year-old Dawson.
She scheduled an appointment for psychiatric care and was prescribed the antidepressant Zoloft, an SSRI medication.
When that caused a severe adverse reaction, she was prescribed Ativan and Benadryl to help her sleep.
By November, she told a nurse at a perinatal behavioural health program she was "very frustrated and scared".
More psychiatric medications followed: Prozac, Ambien, Remeron, Klonopin.
She reportedly told her doctors she could no longer determine what was real and what was not, and by December reported panic attacks and hallucinations.
In a diary which has since been read aloud in court, she wrote she felt "obsessed" with baby Callan's sleep schedule and had "crazy brain fog".
"I now have horrible insomnia and anxiety, which is causing depression," she wrote.
By the end of January 2023, all three children would be dead, and Lindsay Clancy would be paralysed.
Day of killings 'one of her best days', court hears
In the days leading up to January 24, 2023, Patrick Clancy said he took his daughter Cora skiing, while his then-wife stayed home with the two younger children.
"She seemed to be doing a lot better," Mr Clancy would later tell a courtroom.
"[Her] mood seemed better, she was more active and was able to partake in more things."
On that Tuesday morning, Ms Clancy took Cora to a doctor's appointment, and texted her husband pictures of the children throughout the day.
"She seemed happy … [it was] one of her best days," Mr Clancy said.
That afternoon, Ms Clancy suggested getting takeaway from a restaurant, one the prosecution has said was further away than where they would usually order.
Mr Clancy went to pick up the order, stopping at a pharmacy to pick up some medication for one of the children on his way.
While he was there, he called Ms Clancy to ask her about the medication brand.
"[The call] was very brief," he said.
But when he got home, the house was "really quiet", and no one answered when he called out.
Upstairs, the bedroom door was locked. When he forced the door open, he saw "blood everywhere".
Ms Clancy was lying in the backyard beneath the window, having attempted to take her own life.
On a call to emergency services played in court, Mr Clancy could be heard encouraging his wife to stay awake and to look at him.
He then ran back inside to find his three children.
Five-year-old Cora and three-year-old Dawson were already dead. Callan, eight months old, would die in hospital a few days later.
Defence lists dozens of prescriptions for mother who 'wants to die'
There is no debate over whether Lindsay Clancy killed her three children.
Her defence team argues she was a loving mother who was overcome by postpartum psychosis, a rare and severe mental health condition.
Her lawyer, Kevin Reddington, said she repeatedly sought help and was put on medications that made her spiral "out of control".
On the day of the killings, Ms Clancy has said she heard a voice telling her: "This is your last chance. Kill the children so you can kill yourself."
"This is a woman that did not get the medication, did not get the medical treatment that she so deserved," Mr Reddington told the court.
"This is a woman that was suffering from psychosis at the time that she went down to that basement.
"To this day, she wants to die."
She had been prescribed 13 psychiatric medications by different medical professionals, including psychiatrists, nurse practitioners and emergency department doctors, according to court documents.
Evidence presented at trial to date showed she had been issued more than 30 prescriptions in just five months.
But prosecutors say Ms Clancy acted intentionally when she killed her children.
Assistant District Attorney Shanan Buckingham told jurors in court Ms Clancy was "not in the throes of postpartum psychosis" in 2023.
"This was a woman who acted intentionally, rationally and swiftly to accomplish a very specific goal, to kill," Ms Buckingham said.
Ms Buckingham labelled Ms Clancy a "classic overachiever", calling her "extremely controlling, meticulous and manipulative".
"This was a woman who no longer liked the life she thought she wanted," Ms Buckingham said.
Postpartum psychosis a rare but severe condition
Postpartum psychosis affects roughly one in 1,000 women after giving birth.
That is compared to postpartum depression, which affects about one in seven new mothers, according to the Centre of Perinatal Excellence (COPE).
It often occurs in the first few days or weeks after the birth, and women with a prior diagnosis of bipolar disorder are at a higher risk.
COPE's founder and executive director, Nicole Highet, told the ABC it was important to screen for the condition despite it being less common.
"If you are having psychosis … you might have hallucinations or delusions, seeing things that aren't really there or hearing voices," Dr Highet said.
"Typically we think of the person being disconnected with reality and having those symptoms on an ongoing basis.
"But the tricky thing with postpartum psychosis is that these symptoms can sort of wax and wane.
"That's one of the key differentials with postpartum psychosis is that … these hallucinations and delusions aren't happening continuously."
Cases like Ms Clancy's may spark a conversation about postpartum psychosis, but Dr Highet noted the negative attention could lead to additional stigma.
"We need to create awareness about the condition outside of tragedies," she said.
"It's really important we educate all expectant new parents about the fact that we are all vulnerable.
"Your risk of developing a mental health problem when having a baby, during pregnancy or the postnatal period, is higher than any other time in your life."
Civil lawsuits filed as Ms Clancy's criminal trial reaches third week
The trial, already in its third week, is ongoing and expected to last up to eight weeks.
If convicted of murder, Ms Clancy faces life in prison.
Jurors have so far heard from psychiatrists, doctors, first responders, and friends and family of Ms Clancy.
Those who knew her have so far unanimously described her as a loving mother whose mental health was deteriorating.
They said they did not see any signs of psychosis and did not believe she was a danger to herself or her children prior to their deaths.
As the trial continues, Ms Clancy is being held in a public hospital that specialises in treating mental illness.
Patrick Clancy filed for divorce in the months following the children’s deaths, and both he and his ex-wife have filed separate civil medical malpractice lawsuits.
Mr Clancy’s lawsuit has been filed on behalf of his three children, against multiple medical professionals and facilities which treated Ms Clancy.
"[The] bevy of diverse and powerful medications they mis-prescribed coupled with their abject failure to appropriately monitor Lindsay resulted in Lindsay’s mental health deteriorating," the legal complaint alleged.
