What is Post-Partum Psychosis?

It's the Brian Lear Show on WNYC. Good morning again, everyone. I'm Bridget Bergen sitting in for Brian today. A warning for our listeners. This next segment includes discussion of suicide, self-harm, homicide, and severe mental illness. So please take care while listening. If you or someone you know is in immediate danger, call 911 or the 9-88 suicide and crisis lifeline. Pregnant and postpartum people can also call or text the National Maternal Mental Health Hotline at 1833. TLC Mama. That's 1-833-852-6262 for free, and that offers confidential support 24 hours a day, seven days a week. To begin, in Massachusetts, the case of former labor and delivery nurse, Lindsay Clancy is bringing media attention to something called postpartum psychosis. For those who haven't heard about the case, she's on trial for the murder of her three children before trying to kill herself. So far, a lot of that trial has focused on the level of care Clancy received after her youngest child was born. We're not going to focus specifically on that case, but instead we're going to focus on the conversation it sparked related to maternal mental health. Maternal mental health disorders impact 20% of U.S. women, according to the Policy Center for Maternal Mental Health. Despite this number, a 22 study shows that less than 20% of women are screened for maternal mental health disorders. That's both during pregnancy and after the birth. Joining us today to tell us more is Nikki Sapiro Vinkier. She is an OBGYN physician assistant, health educator, and founder of Take Back Trust, a platform helping people navigate reproductive care. She's also the author of We Deserve More, Why Reproductive health care is broken and what you can do about it. She recently wrote a piece for your local epidemiologist called The System Should Be on Trial 2. It's about the ways in which the U.S. healthcare system, in her words, fails new parents in postpartum care. Nikki, welcome to WNYC. Thank you for having me. And listeners, we're going to be taking your calls about postpartum mental health. Do you have questions for our guest about postpartum psychosis or other related conditions? What resources do you wish you had to manage your mental health postpartum? You can call or text us at 212-433 W-NYC. That's 212-433-9692. Again, calls or texts. So, Nikki, to begin,

Let's just define what we're talking about here. What is postpartum psychosis and how common is it actually? Yeah, I'm so glad we're talking about it because I think that this trial is really catapulting this into the news. And I think there is so much that remains unsaid about mental health in general. And when we look at the postpartum period, we're really even lacking that much more awareness and support about what these specific things actually are. So let's start with what we actually call it because a lot of times people just say postpartum. And what they refer to as postpartum depression, but they say postpartum. You know, I experienced postpartum. Everyone who's had a child experiences postpartum. That's the window of time that we consider to be one to two years post delivery of that child. And postpartum depression specifically is the feelings of feeling sad, hopeless, empty most of the day. We can have excessive amounts of crying, feeling like we're losing interest in the things that we used to like, feeling like we're kind of pulling away from our family and friends, having a hard time bonding or feeling close to that baby. Then we also have postpartum anxiety or panic that people can experience, which is that constant excessive worry about the baby's health, feeling restless, irritable, trouble sleeping or trouble staying awake, right? That like racing thoughts or dizziness. the sudden panic attacks that people can have. Those are on the more common side of things. And before we even get to postpartum depression or anxiety is baby blues. So the baby blues is a little bit more fleeing. Those typically happen to actually the vast majority of mothers, like 90% of moms will experience baby blues. And so that can really be fleeing within the first few days. But the postpartum depression or anxiety are the ones that can. linger on beyond that. Then beyond postpartum anxiety and depression, mothers can experience what we call postpartum OCD, which is disturbing or unwanted thoughts about harm to themselves or coming to the baby. It's really, really common for moms to have kind of these worrying thoughts, intrusive thoughts. And so I think that needs to be normalized because so many people experience intrusive thoughts and then think, oh my God, this is crazy. And I remember postpartum with my kids, I'd be. you know, cutting up an apple on the chopping block and you'd have these thoughts of like, what if the knife flies out of my hand and hits my baby, right? These like things that are very unlikely to happen have never happened before, but all of a sudden starts entering into our brain. That can be very normal. As long as you don't have intent to act on that.

that numbers even higher for women of color. Where do you see this gap coming from? It comes from everywhere. It comes from the fact that we don't talk about this often enough in our society that we're shamed to talk about mental health, that we as mothers have been told that we have to be able to carry all things at once and that there's no support for us. I firmly believe that a lot of this is structural and policy issues as well. We don't have... paid parental leave. We don't have easy access and affordable access to child care. There's a lot of different pieces that can play into postpartum mental health. But from that, that's from the patient side as well, but from the clinician side, there is a very significant lack of training on mental health management, specifically in the postpartum period. And what we also see is that in general, There is only one visit that the mom gets at six weeks postpartum, and that's supposed to encapsulate. all of the care that she gets. If you have a C-section, we typically have a two-week postpartum visit as well. So you would have the two-week, which is really kind of like an incision check, and then the six-week postpartum visit. So I think that's a big piece of the puzzle is, you know, you have so many visits leading up to delivery while you're pregnant and incubating this fetus. And then as soon as you have the baby and you get to the other side of it, it's really kind of like falling off a cliff in our healthcare system. And there really isn't any support that's built in. Yeah, I mean, your substack piece gets right at this. And you cited as a systemic failure because, quote, postpartum care has no owner. Can you talk a little bit more of what you meant by that and how that impacts the kind of care people receive? Yeah, I mean, I think that what I just mentioned of the only one visit at that six week visit is really kind of the exact problem named right there, is that women kind of fall in between. Do I need to be seeing my OBGYN still for continued care? Or do I see a primary care? And it's not uncommon for women, specifically women in their reproductive health years, to have an OBGYN only. and not have a primary care. So what we saw with Lindsay Clancy was kind of this like punting through the system of she saw her OBGYN, she saw her primary care, she saw a psychiatrist, a psychologist, she was inpatient and there is no universal healthcare kind of charting system. So often as clinicians, we don't see necessarily what other clinicians have talked to you about, have prescribed, have recommended. And so a lot of it is just kind of like this, this like reinventing the wheel every single time. And we lack that continuity of care and that wrap around embrace of moms in that postpartum period. I want to bring in some of our listeners. Let's start with Tom in Flatbush. Tom, you're on WNYC.

Hi, thank you so much for having me. Thank you for this segment and thank you to your guest. I'm blanking on your name, but I really appreciate this topic. I just wanted to say a few things. One is I'm fairly confident that number because of the stigma around it has to be underreported. This seems to be something that happens a lot and that people don't speak about. It happened to my wife. We are the parents of twin girls. They're very healthy and happy. But our experience was just... really, really terrible, both at NYU, which I highly recommend nobody goes to. They're a factory, and they were really abusive to us and my wife in particular. That being said, I would like to say that I would like to tout the Motherhood Center, which is a premier comprehensive mental health facility dedicated to perinatal and maternal care. They really helped us. Tom, I want to jump in there and just we appreciate your call, but we want to frame that clearly is that was Tom's opinion about their experience. And while we value their experience, we don't want to suggest that that's reflective of all experiences of families that have gone to these centers. But the other issue he raised, the idea that some of these disorders are underreported, Nikki, is something that I think is certainly. feeds right into the conversation of, you know, the lack of understanding and the lack of ownership of some of this care. You know, I have another listener who texted in. Are non-birth parents with pre-existing mental illnesses also susceptible to postpartum? In this case, they're asking about OCD. The listener writes, my husband struggles with anxiety and he experienced severe concerns about our baby's breathing much more so than I did. Can you weigh in on that? Yeah, it can be driven. It can be driven by severe stress and we can see it in both birthing and non-birthing parents. With birthing parents, we see that it's also tied to hormonal shifts, as you can imagine. But in non-birthing parents, it can be related to the stress, decreased sleep, and kind of the whole overhaul of your life. So yes, we do see some of these postpartum mental health issues in men as well. There is a little bit of an increase. increasing call for it not to be called postpartum because they're not experiencing the same hormonal shift. But it is situational for sure. We can see it in fathers and other parents alike. Let's go to Naomi in Martha's Vineyard. Naomi, I think you are, you're in Brooklyn normally, but you're in Martha's Vineyard now. Yes. Go ahead. What's your question? I'm actually... standing in a flower field. My question is about the training of physicians. I've been watching this trial. I have many family members who are physicians. My mom is a psychiatrist. And one of the things that has shocked me is the lack of adequate training for practitioners, not specifically these practitioners. But it's my understanding that there is no specific fellowship program for psychiatrists.

to study parinatal care or postpartum depression and that it is all incumbent on them to attend continuing education courses on their own time rather than experience it as a fundamental core aspect of their training and i just in 2026 that is really shocking to me and i'm wondering if your guest can speak to why that is um the situation if it's the situation and what can we done about it um it is this trial seems like a shocking referendum on the medical system on psychiatry. I think, you know, psychiatrists are wonderful and we shouldn't be scared of them. And I just don't understand why the training is so lacking at this juncture. Naomi, thanks for that. Nikki? Yeah, Naomi, I agree with you wholeheartedly. And actually, this is a big pillar of what I wrote about in my book called We Deserve More, why reproductive health care is broken and what we can do about it. This is not just a commentary on perinatal mental health, which is overwhelmingly lacking in the medical school curriculum and residency program. This is also the same thing that we're noticing and experiencing about menopause education. We see that menopausal education is really insufficient in medical schools and residency. And I think a lot of the issues that we see right now is unfortunately medical care is provided around reimbursement. And we see procedures get reimbursed at a lot higher rate than conversations. So anything that's really part of the relational parts of care, whether it be mental health management, menopausal management, birth control consultations, is really unfortunately not supported in terms of reimbursement and time spent with patients. So I think this is a big, interesting point as to... kind of overhauling the entire system and thinking about how we approach insurance reimbursement as well because as long as it happens that reimbursement is tied to procedures versus you know that conversation reimbursement as well we're going to see that these things continue to be deprioritized but there is an overwhelming call for more education about a lot of these reproductive health care issues not just perinatal mental health within medical schools med students for choice doesn't amazing job in terms of some of these things, not specifically perinatal mental health, but I think this again speaks to this like constant punting around is very few clinicians feel qualified enough to take on a case this nuanced. And so you saw OBGYN punt to psychiatry. Oftentimes psychiatrists feel, you know, it's an unfortunate thing. But in pregnancy, they will punt someone off as well because they don't want to manage medications while someone's pregnant due to risk. And so you need someone who's specifically perinatal psychiatry. And so then you just kind of keep punting down the road. And it's a really broken system that we have. You're completely correct, Naomi. My understanding, Nikki, is that in addition to looking at the ways the U.S. health care system is broken, there are other countries that deal with postpartum in a more effective way. Can you talk a little bit about what you'd like to see from other countries implemented here in the U.S.? Yeah, for example, in Amsterdam they have a...

postpartum nurse who will come to your home for the first 10 days postpartum and provide support and it's covered by insurance in your national insurance nonetheless. In Asia countries we see kind of this like postpartum retreat where there is one hotel but it's wildly unaffordable in New York that does this but it's like a hotel where you're waited on and brought nutritional foods and kind of supported in that early postpartum period. In many Latin American countries, we see a lot higher involvement of family members. In other countries, we see more support from community members, more of the meal train ideas. I think specifically in America, it's a very isolating experience to have a baby, and we're not good enough at asking for help. And as community members and friends, we're not good enough at providing that support either. So I think there's a lot of lessons we can learn from other countries. countries and cultures alike. Nikki, if a listener suspects that they or someone they know might be suffering some postpartum condition, what are the options for treatment and what are the courses of action that people can take? Yeah, so the first thing that I would really recommend, and I suggest this to anyone about their reproductive health care in general, not just mental health issues, but really taking a... intentional and significant approach to tracking your symptoms. So really writing down what it is that you're feeling, how frequently you're feeling it. Is there any time that you feel it more often than other times? Is it throughout the entire day? Is it specifically just with the latch of your baby on your breast or the letdown of your milk, which can occur? Right. Like there's lots of different things and really kind of noticing it. the time you go in to see your clinician, you're not just saying, you know, point blank, I'm feeling overwhelmed. You can more narrowly and specifically nail down exactly what you're feeling so that you can more urgently and impactfully express what's happening to you in your daily life. So I think that really the most important piece of advocating for yourself is triaging yourself. best and foremost first if you are unable to do that which can be the case in many perinatal mental health issues lean on your partner or a friend to be able to to kind of triage this with you. And really bringing those, it doesn't have to be an excessive period of time. It can be a matter of hours or a couple of days. And bringing that with you, I would start with your OBGYN or primary care. You can kind of start in either of those places. If it is something urgent where you have thoughts of self-harm with a plan to act, or you have access to firearms, or you have thoughts of hurting others that needs to be addressed. urgently. And you can, you know, again, call 911 if you have immediate thoughts, otherwise calling the Suicide and Crisis Lifeline at 988. Postpartum Support International is an amazing organization that also provides virtual groups and support. So for any listeners who are listening kind of at anywhere in the world, they have different groups that you can join and.

really get that support that you're looking for. And they do have a Postpartum Support International helplines specifically. That's 1-800-944-4773. So there are a lot of different options that we have available for you. You don't need to do this alone. One of my favorite things that Postpartum Support International does and says is that with help, you will be better. And I think that's one of the biggest issues is that oftentimes in the middle of these deep depths, we feel like it's always going to be like this, that it's not going to get better. How are we ever going to claw ourselves out of this? And I think that really hits the nail on the head. With help, it will get better, right? Knowing that there is another side to this and that with support, we can get you there. I'm going to bring in Mike from Flatbush. Mike, you're on WNYC. Wow, thanks so much for taking my call quickly. And shout out to Tom. I'm also a father of twin girls. I want to bring up the case of Erin Murdy of Coney Island, who was in this past May, sentenced to 20 years to life for drowning her three children in the ocean. She had a three-month-old, and it was clearly, you know, a case of postpartum break. And I'm wondering, that sort of sentence... I don't know anything else about the case, but criminally charging and then sentencing a mother to 20 years to life seems to me in the context of this conversation, and thank you so much for all this information. It just doesn't compute to me. in the short amount of time to reflect on that. Thanks so much. Thanks again. Mike, thanks for your call. And Nikki, I know that part of what Mike is getting it there is something that you wrote about, which is the racial disparity that exists in the diagnosis and identification of some of these postpartum conditions. The case he was talking about specifically was here in New York City. You know, obviously this conversation that we're having, we are referencing a case taking place in Massachusetts. the larger issue of systemic racism and what underpins how women are diagnosed and treated is something that I think he was trying to hone in on. Yeah, and I think, you know, the issue is the really pinning and diagnosis of postpartum psychosis as compared to postpartum depression. And so that lies within obviously the legal system, which is out of my qualifications to weigh in on. But I do think that that discussion and nuance of psychosis specifically is the part that hinges on the trial, if you will.

Let's get one more caller in. Maureen in Ramsey, New Jersey. Maureen, you're on WNYC. This case, I hope, will be a reckoning for women's maternal health. I had my son 34 years ago. He was my fourth child. I was a mess about a month after he was born. And I went to the doctor complaining of not sleeping, not eating, not being myself. And he turned to me and said, well, Maureen, that's what happens when you have four children. And I was beside myself. I really didn't know what to do. Through a circuitous route, I ended up at a psychiatrist about three months later. Within five minutes, he diagnosed me with severe postpartum depression. And thankfully, I was medicated and everything turned out fine. But this case is just breaking my heart. I don't understand how this woman can possibly be prosecuted. She was an advocate for herself. She did everything she could do. And it's just a sin. Maureen, thank you for sharing your perspective and your experience. I want to bring in one more caller, Nikki, who has some questions that I think probably a lot of listeners would appreciate your response to. Let's go to Raul in East Elmhurst. Hi, good morning. Thank you, ladies, for talking about this. As men, sometimes we don't know what to ask or in virus. Yeah, all of those things. My niece just had her second child. What can we ask? What questions to ask? What questions not to ask? Thank you again. Have a lovely day.

Yeah, this is an amazing question. And I think it's really impactful to see so many men weighing in on calling right now. I think that that in and of itself goes to show that in 2026, we do have more buy-in from men around reproductive health care. And so this is decades in the making of really bringing men to the table. And so I want to just name that and show that this is an issue that impacts both men and women in reproductive health care. impacts both men and women. We cannot focus on this solely as a women's issue. This needs to be a family issue. And in order to get this addressed appropriately, it has to be family across the board. So I just wanted to name that first and foremost. And then Raul kind of coming back on that, what I would encourage you to do as somebody who's outside the immediate family as an uncle, it sounds like, is really just observe first and foremost. how your niece wants to experience postpartum. What I see happen often is family members will come in and offer to hold the baby, and then the mom has to run around and do all the 17 other things on their task list. Whereas another option that you can do, is say, hey, I'm here. What works for you right now? Do you want to take a shower? Do you want me to fold laundry? Do you want me to meal prep? Do you want me to run an errand for you? Really kind of looking at the things that are on their list, the things that are more likely to overwhelm them and help them to start. tackling some of those things off of their list. For moms who may be listening, one thing that I see happen often and can be really helpful is as soon as you have something that's in your mind that could be done is put it on a list, write it down on a piece of paper and put that list up on your kitchen island or tape it to your refrigerator. And when somebody comes over, you can direct them to that list to do something for you rather than sitting there and having them say, well, what do you want me to do? nothing comes to mind immediately. So that's a really tangible way of kind of getting some of those tasks of the laundry, the food, you know, taking if there's an older child, taking the older child out of the home is one of the best things you can do, doing bedtime for that older child, giving them a bath, reading them a book, right? Like taking other things off of that parent's plate can be a really helpful thing to do. Wow, Nikki, I think you just gave me some ideas for for things that I will do just in my home now. I'm going to put up that list on the fridge of things if anyone's offering that they can do to help both of the parents in our home. I've been speaking with Nikki Sapiro Vinkier. She is an OBGYN, physician's assistant, a health educator, and author of We Deserve More, why reproductive health care is broken and what you can do about it. Nikki, thank you so much for coming on this show and talking about this really difficult stuff. Thank you for having me. This has been great.