PLYMOUTH, Mass. (AP) — Deliberations in the Lindsay Clancy murder trial have wrapped for the day and will resume Friday morning at 9 a.m. ET in Plymouth, Massachusetts. Jurors must decide whether to hold the former labor and delivery nurse criminally responsible for killing her three children in 2023.

While both sides agree she killed her children, Clancy’s attorneys argued she suffered from postpartum psychosis, with Kevin Reddington saying “ lousy medical care ” exacerbated her condition. Plymouth County prosecutors argued she intentionally planned the killings and that the nation’s healthcare system is “ not on trial here.”

Postpartum psychosis is estimated to afflict 1 to 2 per 1,000 women after delivery. Experts at the Cleveland Clinic describe it as a mental health emergency affecting someone’s sense of reality. It can happen to anyone after giving birth, but the chances are higher for people with certain mental health conditions. Though most people with postpartum psychosis don’t harm their children, mothers with severe cases may try to do so, and also may try to harm themselves.

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Editor’s Note: If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org.

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The charges Clancy faces come with a host of possible penalties

Jurors must decide whether Clancy committed first-degree murder in each child’s death. The charge, which requires proof of premeditation and malice, carries a sentence of life without parole.

If jurors acquit her of that charge, they must consider lesser charges:

Second-degree murder: This carries of sentence of life with the possibility of parole. To be convicted on this charge, the killings must have been deliberate but not planned.

Manslaughter: This carries a sentence of up to 20 years in state prison. It is defined as an unlawful killing without intent to cause harm.

Not guilty: The jury could also conclude that Clancy killed the children but lacked criminal responsibility due to a mental disease or defect. This is known as the insanity defense.

If the jury finds Clancy not guilty, a judge can order an evaluation. If she is found mentally ill and a danger to herself or others, the court can commit her to a state mental hospital for six months. She would be assessed annually, but could remain hospitalized for the rest of her life.

If she is no longer considered dangerous or suffering from a mental illness, Clancy would be discharged.

Clancy’s attorney appears upbeat, confident prosecutors haven’t proven their case

As he left court on the first day of deliberations, Clancy’s defense attorney, Kevin Redding, appeared upbeat and said he felt the jury would reach the right conclusion.

“I think that they have to weigh all of this evidence, and I believe that the government ultimately has not proven their case,” he said.

Reddington described Clancy as “nervous” and “scared” as the jury considered her fate.

Along with a scores of reporters, Reddington also was greeted by a few supporters.

Deliberations end for the day

The judge says he’s sending the jury home for the night.

Deliberations will resume at 9 a.m. Friday.

The charges Clancy faces come with a host of possible penalties

Jurors must decide whether Clancy committed first-degree murder in each child’s death. The charge, which requires proof of premeditation and malice, carries a sentence of life without parole.

If jurors acquit of her that charge, they must consider lesser counts.

Those include second-degree murder, which carries of sentence of life with the possibility of parole. To be convicted on this charge, the killings must have been deliberate but not planned.

If they find her not guilty on that charge, the jury will consider a manslaughter conviction, which carries a sentence of up to 20 years in state prison. It is defined as an unlawful killing without intent to cause harm.

The jury could also conclude that Clancy killed the children but is not guilty because she lacked criminal responsibility due to a mental disease or defect. This is known as the insanity defense.

If the jury finds Clancy not guilty, a judge can order an evaluation. If she is found mentally ill and a danger to herself or others, the court can commit her to a state mental hospital for six months. She would be assessed annually, but could remain hospitalized for the rest of her life.

If she is no longer considered dangerous or suffering from a mental illness, Clancy would be discharged.

Judge describes the difficulty of murder trials

After jurors left the courtroom, Sullivan commended the prosecution and defense for their efforts.

“Unless you’ve tried a difficult murder like this one, you may not be aware how difficult and tough it is to try a case like this,” he said. “It’s emotionally taxing. It’s intellectually challenging. It’s physically exhausting.”

Jury begins deliberations

The jury has started to deliberate in the murder trial of Lindsay Clancy, a mother accused of strangling her three young children in a case that has drawn attention to postpartum mental health. Clancy has pleaded not guilty by reason of lack of criminal responsibility. Her lawyers have argued she was experiencing postpartum psychosis when she killed Cora, Dawson and Callan Clancy at the family’s home in coastal Duxbury, Massachusetts, in January 2023. The rare mental illness is linked to the stress, sleep deprivation and hormonal changes that follow childbirth. Prosecutors say Clancy planned the killings and understood her actions were wrong. Jurors must decide whether she was criminally responsible and, if so, exactly what crimes she committed.

Judge appoints a foreperson before deliberations begin

Before the jury left the courtroom, Sullivan appointed one of the jurors, identified only as No. 257, as foreperson.

He told them a deliberation is not an easy task, and to respect each other’s opinions.

Judge explains ‘proof beyond a reasonable doubt’ to the jury

Sullivan has told jurors that Clancy retains the presumption of innocence unless they find her guilty.

“Proof beyond a reasonable doubt does not mean proof beyond all possible doubt, for everything in the lives of human beings is open to some possible or imaginary doubt,” the judge says.

“The charge is proved beyond a reasonable doubt if, after you’ve compared and considered all of the evidence, you have in your minds an abiding conviction to a moral certainty that the charge is true.”

Closing arguments end, jury hears more instructions

Sprague has ended her closing argument describing how horrific and cruel the killings were.

“She left them discarded on the basement floor like broken toys because she was done playing the game,” Sprague says. “You know to a moral certainty she is guilty.”

The judge is now giving the jury more instructions ahead of the start of deliberations.

State provides its theory for why Clancy killed her children

Sprague confronts one of the central questions in the case: Why would a mother who loved her children kill them?

“She was depressed. She was exhausted. She was done. She didn’t want to try anymore. She felt damaged,” Sprague says. “But those kids, those kids were her protective factor. Those kids were keeping her from ending her misery.”

And so, Sprague says, Clancy “had to remove the protective factor.”

Sprague adds Clancy had other options, including moving to her mother’s for more support or killing herself and leaving the kids alive.

“It was a choice to take them with her. It was a horrible choice,” the prosecutor says. “It is a choice that we don’t want to think about that a mother could make, because that doesn’t make us feel safe or comfortable in this world. But it’s a choice she made.”

Prosecutor says evidence shows Clancy planned the killings

Sprague alleges Clancy sent her then-husband to get some takeout food at a local restaurant to give her time to kill the children. She even checked a map to see how long it would take him to collect the food and return home.

“What she needed to know was how long specifically on that night it would take to get there,” Sprague says, “because she knew she would have a limited amount of time to do what she wanted to do. And what she had decided to do was to kill the children and then kill herself.”

When Clancy saw she would need more time than the restaurant trip would take, she asked her then-husband to also pick up medication at a local pharmacy, Sprague says.

“She’s adding to this errand and she has to make sure she’s not interrupted,” Sprague says.

State says Clancy lied to mental health providers about her dark thoughts

Sprague says Clancy’s decision not to tell her mental health providers about thoughts she had in December 2022 of harming her children shows she understood those thoughts were wrong.

Clancy disclosed the thoughts to her then-husband and to her mother, but not to her doctors, Sprague says.

Clancy feared her children could be taken away if she told a mandated reporter, Sprague says.

“That’s a rational thought,” Sprague says. “It also shows you that she knew it was a bad thought, a wrong thought.”

“Not only is she hiding it. She is lying about it.”

Prosecution questions Clancy’s adherence to treatment

Prosecutor Jennifer Sprague acknowledges that Clancy sought help for her mental health struggles, but argued that she did not always take medications as prescribed or give her providers complete and accurate information.

“She wanted to get better, but she wanted to get better on her own terms,” Sprague says. “And as a nurse, she knew that’s not the right way to approach it.”

Sprague rejects the defense’s argument that Clancy did not receive the care she needed, saying her providers were working with the information Clancy gave them.

“This doesn’t mean that she wasn’t struggling, that she wasn’t dealing with these mental health issues,” Sprague says. “She had depression.”

But, she adds: “They were doing the best they could with her level of cooperation and compliance with the plan.”

Prosecutor begins her closing argument

Prosecutor Jennifer Sprague says the case isn’t about the “mental health system or how it treats women.”

“That’s a distraction to get you angry and passionate about an important issue, but an issue that’s not on trial here,” she says.

The case, Sprague says, is about whether Clancy could recognize what was wrong with her actions and conform her actions to the law. In Clancy’s case, she had more support and resources than most have when navigating the American healthcare system.

“This wasn’t a woman suffering from a lack of care, a lack of resources,” she says. “She had an abundance of health, an abundance of care. She had all of that and more.”

Clancy wrote about her ‘horrible, intrusive thoughts’

Before Reddington concluded his closing argument, he held up a poster board with some of Clancy’s desperate writings as her mental health deteriorated.

He says she was in “the depths of the despair” before the killings.

She wrote that he was having “horrible, intrusive thoughts” that prompted her to seek treatment.

At one point, her writings became like gibberish, he says.

“There’s nothing other than little chicken scratches because her mind was gone,” Reddington said.

Reddington describes Clancy attempt to research support for postpartum depression, called a suicide hotline, visited multiple providers and was voluntarily admitted to a psychiatric hospital.

“My God, what does she have to do? She was reaching out for help and she wasn’t getting it,” he says.

Lawyer talks of Clancy’s deterioration during mental health treatment

Reddington has told the jury that Clancy ’lived for her kids” but after she starting seeing a doctor, “it was not a wonderful life anymore.”

“You have the medical records. You heard the testimony. You know her concerns. You know her fears,” Reddington said. “Does this sound like a young lady that didn’t care and wanted to score more drugs off somebody? That’s another repulsive allegation.”

Reddington holds up a poster board with some of Clancy’s desperate writings as her mental health deteriorated.

He says she was in “the depths of the despair” before the killings.

Reddington talks of Clancy’s devotion to her children

The defense attorney holds up a small “wish box” that Lindsay Clancy and her then-husband, Patrick, bought on their honeymoon in Hawaii, before they had children.

Over the years, the couple filled the box with slips of paper recording their hopes for the future. Some were dated 2017, 2018 and 2020.

“They reference her wishes to have healthy kids, her wishes for her kids to be successful, her wishes to have a good birth the second time around,” Reddington says.

The box offers a glimpse of the life the couple had imagined for their family years before Clancy killed their three children, he says.

Defense lawyer criticizes prosecution’s case

Reddington is reminding jurors of what he told them at the beginning of the trial.

“In my opening statement, I told you, I said, ‘Watch the evidence, watch the manipulation,’ because that’s what this case was built upon originally and how it developed as the case progressed until it’s in front of you,” he says.

Reddington says the prosecution has tried to paint Clancy’s suicide attempt as less serious than it was.

“She made a very, very significant suicide effort,” he says. “They were arguing that it was a fake suicide. Dinky little cuts. No bleeding … You know that’s not what happened.”

Closing arguments begin with Reddington for the defense

Reddington is up first.

He thanks the jury for their service during the monthlong trial, through tough and gut-wrenching testimony.

“Sadly, juries carry this burden with them for years,” Reddington says.

He names all three children.

“They are the victims in this case,” Reddington says.

Clancy listens to the jury instructions

Lindsay Clancy stares straight ahead as the judge goes over the instructions.

At one point, she dabs her eyes with a tissue.

Jurors hear instructions on law before closing arguments

Judge William Sullivan printed out a copy of the instructions for the panel.

He reminded jurors that Clancy is innocent until proven guilty, and went over the elements of the charges.

He said a defendant is not criminally responsible for their conduct if they have a mental diseases or defect.

Sullivan tells the jury that they will consider three counts of murder in the first degree for each of the children but can consider murder in the second degree.

“If you find the defendant guilty of murder you shall decide the degree of murder,” he told the jury.

The judge says a defendant may form the required intent needed to prove a murder charge and act with premeditation even if she suffered from a mental impairment or consumed prescription.

The courtroom is full

The doors of the courtroom have opened and about 90 people have shuffled inside.

The Plymouth County District Attorney’s office has several people in the front row, including District Attorney Timothy Cruz.

Clancy’s defense attorney, Kevin Reddington, is pacing back and forth and Clancy has yet to arrive.

Clancy’s parents Mike and Paula Musgrove are in the front, sitting alongside members of Reddington’s defense team. Neither Patrick Clancy nor his family are here.

The courtroom is filled.

Clancy lawyer says the trial has raised awareness about postpartum psychosis

“A month ago, five weeks ago, I didn’t know anything about this, and it’s just been quite a very, very scary eye-opener for me,” defense attorney Kevin Reddington told The Associated Press before proceedings began Thursday.

“I do hope that it has opened a discussion and people realize how serious this is. The mother’s postpartum depression, postpartum psychosis, the babies, the statistics, it’s just horrifying,” Reddington says. “And you cannot just deal with human beings in that type of distress on a telemedical Zoom call and throw pills at them.”

Asked how Clancy has been coping during the trial, Reddington said “not well,” describing her as scared and sad.

Reddington declined to offer a preview of his closing argument, saying he had nothing written down and would decide what to say when he got to the courtroom.

Clancy supporters are in the crowd outside the courthouse

Many are dressed in pink and calling attention to women’s mental health issues.

“I feel that mental health is at the cornerstone of this, but so is community, family — and we need to believe women,” said Marta Quijano. “And we need to support people and help people when they ask for help. And as a physician myself, I’ve been on both sides of this coin when women are dismissed for our concerns, and it’s not fair.”

Lyn Feeney said women suffering in their mental health, especially new mothers, need support from a variety of people.

“The more children you have, the harder it gets,” she said. “So I feel like women just need support from mental health professionals, physicians, family and the justice system.”

People are lining up outside courthouse

About 75 people were waiting around 7:30 a.m. ET to get into the Plymouth County court building, including journalists and other members of the public.

Several media outlets have set up canopies on a nearby grassy area. A handful of people wearing pink in support were also in line.

Signs and treatment for postpartum psychosis

Postpartum psychosis usually happens within several days of giving birth but can occur up to six weeks afterward.

Symptoms may include hallucinations, delusions, paranoia or other behavior changes.

A woman may also have mood changes, such as mania or depression, disorganized thinking or behavior, insomnia, irritability or agitation.

Mothers with the condition need inpatient mental healthcare, which can include involuntary hospitalization. Treatments include medications or electroconvulsive therapy, a procedure done under anesthesia in which small electric currents pass through the brain, intentionally causing a brief seizure.

Experts say getting help early increases the odds of a good outcome.

What to know about postpartum psychosis

Postpartum psychosis is estimated to afflict only 1 to 2 per 1,000 women after delivery. Experts at the Cleveland Clinic describe it as a mental health emergency affecting someone’s sense of reality.

It can happen to anyone after giving birth, but the chances are higher for people with certain mental health conditions. In a journal article on the subject in 2023, researchers at the Medical University of Lublin in Poland said about half of people with postpartum psychosis have a previous history of psychiatric problems and the most common risk factor associated with the condition is bipolar affective disorder, which causes extreme mood swings.

Though most people with postpartum psychosis don’t harm their children, mothers with severe cases may try to do so, and also may try to harm themselves.

Experts say it’s important to seek immediate help if you or your partner or family member show signs of postpartum psychosis.