A note of caution: This story contains mentions of suicide. Please take care when reading. If you or someone you know may be considering suicide or is in crisis, call or text 988 to reach a crisis counselor.
A widely publicized murder trial is highlighting gaps in mental healthcare among new moms. McLean County healthcare providers say postpartum depression is more common than people realize. A pair of OSF HealthCare nurses who serve new moms all over Illinois said they triage patients up to five or six times a day for the condition.
A rarer and more serious condition, postpartum psychosis, is at the center of an ongoing Massachusetts triple murder trial. Defendant Lindsay Clancy claims she killed her three children and tried to take her own life during an episode of postpartum psychosis in January 2023. She is paralyzed after attempting suicide, jumping from a second-story window.
Clancy has pled not guilty by reason of insanity. She said she was experiencing auditory command hallucinations, including a loud male voice which told her she had no choice but to kill the children and kill herself. The defense claims she developed postpartum mental illness in the fall of 2022 and sought help from multiple different medical providers, family members, suicide hotlines and even inpatient facilities.
'Very, very common'
Postpartum depression is the "most common medical complication" among postpartum moms, said Bri Jochman, an OSF nurse with the OnCall Connect Pregnancy and Postpartum Support program [OnCall]. Jochman works to screen new moms for depression, anxiety and other postpartum health complications.
"I think we probably triage or talk moms through postpartum depression and anxiety symptoms, definitely daily, if not five, six times a day," said Jochman. She said these symptoms are "very, very common. Our team is very well equipped for this. We have specialized training experience."
Kate Johnson, Digital Care Manager with OSF who oversees the OnCall program, said it was launched in 2022 to address gaps in postpartum mental healthcare — specifically access to quality healthcare for low-income moms.
Danielle Gilow, another OSF OnCall nurse, said that the around-the-clock nature of the program is what helps. As a new mom herself, Gilow remembers some lonely moments when she needed help. "I think that we can all agree we leave our O.B. visits and we have questions, or there's care gaps — and we go home, and it's nighttime, and we have no one," she said.
Often, Gilow said women reach out unclear about what they even need; they just know they need help. Gilow said that the entire staff of OnCall Postpartum Support nurses are moms themselves, which helps build trust quickly. She said their goal is to listen and guide them to resources that can help.
Beyond typical baby blues
Jochman said the postpartum "baby blues" are common up to two weeks after delivery. She said this is due to major physical, emotional and hormonal changes that occur after delivering a baby. After that, she advises patients, "if you notice your symptoms are persistent or worsening, to reach out right away."
Gilow said common symptoms of depression or anxiety include extreme fatigue, lack of energy feelings of guilt or shame, or "retracting from normal activities, family and friends, not really being present in the conversation as you normally did."
She said they can sometimes include "a lot of sadness, crying," or "racing thoughts."
Gilow said symptoms vary for everyone. New moms have so much going on, she said, it's crucial for partners, friends and family to watch out for warning signs about their mental health.
"I find it very important to make sure that the people who are closest to the patient are also aware and on the lookout for those symptoms," she said.
Gilow said patients who had mental health issues prior to pregnancy and delivery, whether or not those issues were diagnosed, are at a higher risk for postpartum depression or anxiety. But it can also impact women who have had no prior mental health issues, she said.
Postpartum psychosis
While Jochman said postpartum depression is very common, postpartum psychosis "is much more rare."
She has only seen one case of it in the four years she's been with the OnCall program.
"It is a medical emergency and it needs to be addressed immediately," she said.
Victoria Magruder is a licensed clinical social worker and works as a behavioral health specialist for OSF. She practices in Godfrey, Ill. and serves patients all over Illinois, including McLean County.
Postpartum psychosis is far less common than postpartum depression, but Magruder said "it's actually more common than we really know about."
Magruder said postpartum psychosis occurs in "anywhere between one or two births per 1,000 births."
The McLean County Health Department reports an average of 2,335 annual live births since 2017. With those statistics, it’s possible that two to four women each year experience postpartum psychosis in McLean County.
In addition to the symptoms of anxiety and depression, Magruder said moms experiencing postpartum psychosis also have delusions and hallucinations. She said they are "experiencing a different type of reality," which is why "it is so dangerous and it's so important for moms to get the support that they need."
Women experiencing postpartum psychosis believe their delusions and hallucinations are true, Magruder said, which "can really cause some significant harm to them or to their baby."
In a non-psychotic state, she said that the woman would not normally want to harm her baby.
"It's just the delusions and the hallucinations that are making her feel like she should," she explained.
Psychosis symptoms "really can come in waves," Magruder said. She said symptoms can shift unexpectedly from more common anxiety and depression symptoms to "believing those things that are no longer reality."
The "extreme hormonal and life changes" that women experience after giving birth make mental health unique at that stage of life, Magruder said. She cited sleep deprivation, appetite changes and trouble breastfeeding as new experiences that could contribute to mental health problems for moms.
Magruder said women with Bipolar I disorder, whether diagnosed or not, are at a slightly higher risk for postpartum psychosis. However, for the most part, Magruder stressed postpartum psychosis "is an equal opportunity illness. It doesn't discriminate."
She said women of all races, socioeconomic statuses, and previous mental health experiences are at risk for postpartum psychosis. This also makes it difficult to screen and prevent, she said, which makes it even more important to diagnose at the time of symptoms.
Magruder said she has yet to witness postpartum psychosis firsthand.
"I think it's only a matter of time until I have that ability to work with those moms in our community," she said "and I'm always on high guard when I work with moms that are going through postpartum to make sure that's not what they're experiencing."
Signs of distress
Like Jochman and Gilow, Magruder emphasized how important it is for loved ones of a new mom to watch out for her mental health.
"We really want to support mom because it's such a vulnerable time. Their hormones are going through so much. Their sleep is going through so much."
Magruder said she receives many postpartum mental health referrals from pediatricians who interact most with new moms. She said in the first year, they are "going to be going to the pediatrician way more often than they're taking care of their own health."
She said pediatricians play an important role in "encouraging mom," while she also receives referrals from primary care physicians.
As far as what to watch out for, Magurder said "bizarre behavior that was not like them before" is an indication that postpartum depression or anxiety could be escalating into postpartum psychosis.
"Maybe that's them talking about like specific anxious thoughts, or anxious fears about baby, or about them."
She also said behavior changes like "not wanting to take baby by a bathroom, or not wanting to take baby by stairs," are signs of trouble. She added that some delusions can be religious in nature, referencing God or the devil.
Loved ones should ask themselves, "Is she acting how she used to act?" Macgruder said. If a new mom is displaying symptoms of postpartum psychosis, Magruder said the best course of action is to treat it as a medical crisis, and go to the emergency room right away.
OnCall support in Central Illinois
The OnCall program is completely virtual and available to all patients in Illinois who deliver a baby while covered by Medicaid. Additionally, any woman who delivers a baby in an OSF-affiliated hospital, regardless of insurance status, has access to the program.
Johnson said it starts at week six of pregnancy and formally continues until six weeks postpartum, but moms often continue calling beyond that timeframe.
Healthcare professionals have a variety of definitions of when the postpartum period officially ends. Many say six weeks, but Magruder said, realistically, it takes more like a year or two for a woman's body to go "back to where it was beforehand."
She said in a therapy setting, the postpartum period lasts for closer to a year, and symptoms can change during major changes. Macgruder said these can include a woman returning to work or making changes to breastfeeding habits.
When moms who are more than six weeks postpartum call the OnCall program, nurses there still help. Johnson said "because of our mission to serve with the greatest care and love, we continue to respond to women who reach out to us through the Get Well platform if they need help" beyond six weeks.
On average, Johnson said there are more than 1,000 women across Illinois enrolled in the OnCall program each week, in various stages of pregnancy and postpartum.
Through an app called Get Well Anywhere, Johnson said patients can interact around the clock with trained postpartum nurses via chat, email or phone call. Patients can share photos and providers can share links to resources.
Jochman said women often just need someone to listen. If they need more care than that, the OnCall nurses are ready to act.
"Especially if the symptoms they report are concerning, we can call and triage immediately," Jochman said.
Jochman said even when working with postpartum moms on topics unrelated to mental health, she remains on "high alert" for mental health red flags.
"I think they're doing well, but then they make little comments that I'm able to assess right then and there, and notice, okay, this mom really is not doing well," she said, "and so we can kind of take action at that point."
In additional to mental health support, Jochman said the OnCall nurses also provide help accessing basic needs such as food, housing, and transportation. Jochman said it's important not to "lose track" of the patient after the referral. "We have very close follow up," she said.
