We Medicalized the Mother. What Happened to the Village?

On September 9, I was on Awake Nation. Dr. Andrea Nazarenko was also a guest, and I wanted to share this Substack article with you all.  She does a good job talking about what Lindsay Clancy’s tragedy can teach us about postpartum depression, social support, and the story we tell about maternal mental health.

Reprinted with permission from Dr. Andrea Nazarenko’s Substack

Every few years, a case comes along that isn’t really about the person on trial.

Commonwealth v. Lindsay Clancy is one of those cases.

On the surface, it is a murder trial for Lindsay Clancy, a labor and delivery nurse who allegedly killed her three children before attempting to take her own life. But dig deeper, and this trial is raising questions much larger than Lindsay’s fate alone.

While the jury hears evidence on her mental state at the time of the alleged killings, many mothers are recognizing something painfully familiar:

What it feels like to need help and not be heard.

Our maternal mental health system has focused so heavily on what is happening inside the mother — e.g., her brain, hormones, symptoms, diagnoses, and medications — that we have overlooked something critical, yet hiding in plain sight: The environmental conditions surrounding modern motherhood.

This Substack is not intended as a summary of the Lindsay Clancy trial, nor is it a stance on her innocence or guilt. It is about what the trial has revealed about the state of maternal mental health, and how the needs of mothers have been largely ignored.

NOTE: Postpartum mental illness is not one thing. It can include depression, anxiety, obsessive-compulsive symptoms, mania, psychosis, and other forms of psychological distress. These conditions are distinct and should not be collapsed into a single diagnosis. For simplicity, in this piece, I will focus primarily on postpartum depression (PPD) because it is the most extensively studied, while drawing on the broader postpartum mental-health literature where relevant.

The Village Was the Medicine

There is no doubt that Lindsay was suffering tremendously. She was in acute distress. She sought help. Again and again.

And, again and again, much of that help came in the form of a prescription.

Lindsay’s story forces us to ask what we have come to mean by “help” for a struggling mother. Increasingly, the answer has become professional care.

A doctor.
A therapist.
A diagnosis.
A pharmaceutical.

But care for mothers was never meant to exist only within the walls of medicine.

There was a time when children were born to mothers.
And mothers were born to villages.

Birth was not simply a medical event to be managed. It was a human event, a community event, and, in many traditions, a sacred one.

When the baby was born, the village surrounded the mother:

Meals were provided.
Breastfeeding was supported.
The baby was held so mama could sleep.
Other children were cared for.

The mother raised the infant.
The village raised the mother.

Somewhere along the way, we lost much of this village.

Pregnancy and childbirth moved increasingly into the domain of medicine, while the rest of motherhood moved in the opposite direction: into the private lives of mothers and their immediate families.

We medicalized birth.
We privatized motherhood.

And now we are beginning to see what that has cost us.

 

The Hormone Story

In modern Western society, postpartum depression (PPD) and hormones have become almost inextricably linked.

The story is familiar. A narrative told time and time again. It goes something like this:

During pregnancy, a woman’s hormones surge. After delivery, they crash. That sudden hormonal withdrawal can wreak havoc on her mood, resulting in postpartum depression, anxiety, or even psychosis.

There is truth in the first part of that story.
The question lies in the second half.

During pregnancy, estrogen and progesterone rise dramatically to levels above their pre-pregnancy baseline. After delivery, both fall precipitously, with most reproductive hormones returning toward pre-pregnancy levels within the first one to two weeks postpartum.

There is no doubt that pregnancy and childbirth involve profound hormonal shifts.
This hormonal cliff is nearly universal. Postpartum depression is not.

If the hormones alone caused postpartum depression, we would expect women who develop PPD to show measurable differences in the hormonal process.

A bigger drop.
Lower postpartum hormone levels.
…Something.

Surprisingly, this isn’t what the research shows.

Systematic reviews have found little consistent relationship between postpartum depression and estrogen or progesterone levels, or even the magnitude of the hormonal drop from pregnancy to postpartum.

Hormonal levels and patterns alone do not reliably distinguish mothers who develop PPD from mothers who do not.

In a fascinating experiment, NIH researchers simulated the hormonal rise and withdrawal of pregnancy and childbirth in women with and without a history of PPD. Five of eight women with a history of PPD developed significant mood symptoms. Not one of the eight women without a history of PPD did, despite being exposed to the same experimental hormonal conditions.

Same hormonal manipulation. Very different response.

Breastfeeding adds another wrinkle to the hormonal explanation of PPD. Lactation maintains a hormonal state quite different from a woman’s pre-pregnancy baseline. Prolactin remains elevated, breastfeeding triggers repeated releases of oxytocin, and reproductive hormones remain altered while lactation suppresses normal ovarian cycling.

If simply remaining hormonally distinct from one’s pre-pregnancy state were the underlying factor in PPD, we would expect breastfeeding to increase vulnerability to distress. Yet breastfeeding is generally associated with lower rates of postpartum depression, not higher ones.

The hormones may be nearly universal. The outcome is not.

The question, then, is not simply what happens inside the mother that leads to postpartum distress, but what is happening around her.

Where Did the Village Go?

The village that raised the mother has largely disappeared from modern Western motherhood. Efficiency, productivity, and an expectation of self-sufficiency have replaced support, interdependence, and rest.

 

Across cultures, the conditions surrounding new mothers vary enormously. In many traditional societies, the postpartum period remains socially structured around rest, nourishment, practical help, proximity to family, and support from other women. Research increasingly suggests that these conditions matter.

In an interesting 1983 anthropological analysis of cross-cultural literature, Stern & Kruckman explored the impact of the cultural patterning during the postpartum period. The authors delineated a common set of features across traditional cultures that protected against postpartum distress: a defined postpartum period, mandated rest, practical assistance from relatives or midwives, protective measures for the new mother, social seclusion, and ritual recognition of her new status. They proposed that the comparatively high levels of postpartum distress observed in the U.S. might be related, at least in part, to what they called the lack of “social structuring of the post-partum period.”

Recent research extends this work, adding that it is not the tradition itself but rather the relationships and support embedded within the traditions that matter. A 2023 systematic review of social support and PPD across Asian countries found that support from close relatives, particularly partners and mothers, was important to postpartum well-being. Traditional postpartum practices could provide valuable emotional and practical support, but they could also become a source of stress depending on the relationships surrounding the mother.

Tradition is not the medicine. Support is.

The biology of childbirth may be shared. The conditions surrounding it are not.

The Numbers Don’t Lie

The apparent limitations of the hormone hypothesis made me curious about what actually predicts postpartum depression.

My search of the literature included a review of multiple meta-analyses and prospective studies, including a 2026 umbrella review that synthesized 77 meta-analyses and 53 different risk factors for PPD. Because hormone-related factors were surprisingly sparse in the evidence synthesized, I also searched specifically for studies examining hormonal predictors and comparative studies that explored both biological and environmental factors that may not have been captured in prior studies.

A NOTE BEFORE WE GO FURTHER:

What follows may be difficult for some women who have experienced PPD to read. None of this is intended to judge, diminish, or explain away anyone’s experience. Quite the opposite. If the conditions surrounding a mother affect her risk of suffering, then recognizing those conditions doesn’t place more responsibility on the mother. It places responsibility on all of us to ask whether we are giving mothers what they need.

What follows is not conjecture. It is what decades of research into the predictors of postpartum depression have repeatedly found.

What actually predicts postpartum depression?

A synthesis of the results across the literature appears in the table below.