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She Killed Her Children. Can We Forgive Her?

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Postpartum psychosis affects one to two moms out of 1,000 births, but many reproductive psychiatrists believe that is an underestimate because the symptoms are easy to miss, and the doctors who most often see new moms are not trained to recognize them. (Kelly Heigert/KQED)

Years later, Rudy Coronado still refers to what happened as "that day." He thinks about what he said, what he didn't say and what he wishes he could take back. The signs he missed – and the signs he saw, but ignored.

"That day, Carol was acting kind of weird," he stammered. "She was just different."

Not different the way his wife was usually different, the traits that charmed Rudy when they first met at a doughnut shop in Carson: her simple, no makeup, no celebrity gossip style; her book-loving, hard-working focus.

Not quirky, the way she was quirky, separating the rice and beans and vegetables on her plate, and always eating one thing first.

Not precise and meticulous, the way she learned to be in the military and then later applied to motherhood, keeping spreadsheets on all the daily activities of their three daughters: Sophia, 2, Yazmine, 1, and Xenia, 3 months.

"Every time she breast fed, every bottle she gave them – everything was documented," Rudy said. "Every time they pooped, how they pooped, everything. Everything."

That day, May 20, 2014, was different. Carol seemed to wake up in a panic. She called her mom over and over, leaving one desperate message after another: "Mommy, please call me. Please — Please — Please. I'm tired. I'm exhausted. I'm hungry," she said, crying and rambling until the voicemail system cut her off four times in a row.

By the sixth message, Carol sounded spent: "Mom. Please call me. I love you. Bye."

By the afternoon, Carol was barely saying anything.

When Rudy came inside after working on his '68 Chevy truck across the street from their home in Torrance, Sophia was running around with no diaper on. There was poop on the carpet, poop on the walls, poop on her hands. Carol was lying on the bed. Her eyes were blank, black.

Rudy started yelling. And that's when he said the thing he wishes he hadn't.

"I was like, 'Carol – to what extreme is this going to get to?' And I regret telling her that," he said. "Because I don't know if that's what kind of sparked her to do something dumb? To do that?"

Rudy went back outside. He was working on his truck when Carol's mom came over after her shift driving a local school bus. She went into the house, then ran out, screaming.

All three girls were dead. Carol had taken a knife from the kitchen and stabbed them each in the throat and through the heart. Then she laid them on the bed, in order from youngest to oldest.

"At first glance, it was weird, 'cause I didn't see no blood. I don't remember seeing blood. So when I walked up and I touched Sophie, she was cold," he recalled, his voice catching. "I was like, 'What'd you do?' I couldn't believe my eyes."

Carol looked at Rudy and told him she loved him. Then she pushed the knife into her own chest.

The Victim or the Monster?

Carol did not die that day. If she had, perhaps she would have been mourned, alongside her daughters, as one of the victims of an inexplicable tragedy. But her survival meant that day would have to be explained — in court, by prosecutors, who would cast Carol as a criminal, driven by revenge, and deserving of society's harshest judgment.

Even though several psychiatrists testified that Carol was suffering from postpartum psychosis, a severe mental illness triggered by childbirth, the judge would set that evidence aside: The law used to evaluate these cases was written a century before any doctor had uttered such a diagnosis, and the web of clinical symptoms simply doesn't fit the legal test for insanity.

In California, more than 100 women are in prison for killing their children, data analysis by KQED shows. The state prison system doesn't track these numbers, so KQED reviewed thousands of court records and news reports to calculate them. Forty percent of these women took their baby's life before they were a year old. Seventy percent of those women are serving life sentences.

This doesn't happen in other developed countries. England, Canada, Australia, Japan, Brazil, Sweden and more than a dozen other nations have specific laws for these cases. Most are modeled after Britain's Infanticide Act, which says if a woman harms her child within a year of giving birth, it is presumed she suffered from a postpartum mental illness. She is often sentenced to treatment, not incarceration.

"There’s an assumption that something was off," said Diana Lynn Barnes, a psychotherapist in Southern California who frequently serves as an expert witness in infanticide cases. "Most of the time these women are found guilty of manslaughter, and in many cases they don't even go to prison."

A few states have pushed for similar laws to allow judges to reconsider and lower harsh sentences with evidence of postpartum mental illness in mind. Only one succeeded: Illinois in 2018. When California advocates broached the topic that same year, they said lawmakers told them, "No, not now."

Without a uniform standard for these cases in the U.S., judgments have been arbitrary and variable, from life without parole to probation, often depending on the sympathies of the judge or jury. Most courts continue to view women who harm their children the same as trained assassins, experts say.

Carol Coronado was charged with three counts of first-degree murder. The Los Angeles County District Attorney’s Office considered seeking the death penalty.

'It Was the Disease'

The first time Rudy and Carol Coronado ever heard of postpartum psychosis was after Carol was taken to jail.

Doctors later told them that Carol's break from reality was caused by hormonal changes from her last pregnancy, lack of sleep and the relentless cycle of breastfeeding and caring for three babies under three. Two-thirds of women who kill their children following childbirth suffer from postpartum psychosis, a 2000 study found.

"Everybody who saw her, all of the doctors, within hours and days of this event found that she had some kind of a psychotic disorder," said Barnes, the expert witness in Carol’s case.

Carol's bizarre behavior, her confusion and detachment, she said, these are all symptoms of postpartum psychosis — and they can develop without warning.

"She will look disheveled, not just unkempt, but disheveled. She'll start to look glazed over," Barnes said. "She may be looking around as though she's taking things in from the environment that may or may not be there."

Rudy finally had an explanation for Carol's sudden change in behavior.

"I was thinking like a demon possessed her or something because her eyes went black," he said. "Now I know that it was the disease."

That's what frustrates Rudy now — knowing there's treatment that could have cleared Carol's symptoms and prevented what happened that day. If he had only known what he was seeing and what else to look for.

Postpartum psychosis affects one to two moms out of 1,000 births, but many reproductive psychiatrists believe that is an underestimate because the symptoms are easy to miss, and the doctors who most often see new moms are not trained to recognize them.

"Postpartum psychosis often presents with delirium-type symptoms, mainly confusion and disorganized thoughts and not classic hallucinations or paranoia," said Nirmaljit Dhami, a reproductive psychiatrist in Mountain View. "And the symptoms wax and wane. I had one patient who was confused at times and very clear at other times."

Women with postpartum psychosis often experience a mood disturbance, too, either mania or depression. Carol's lawyer argued she was depressed, but that her doctors missed that, too. Her primary care doctor, Bijan Ghatan, testified at her trial that Carol didn’t "seem depressed" to him, when he saw her six days before the deaths.

"She was her usual jovial self," Ghatan said.

This was 2014, four years before the American College of Obstetricians and Gynecologists rewrote its guidelines to recommend doctors administer a formal screening test for postpartum depression, and five years before California law made the test mandatory. So Carol's doctor said he didn't do one. He said Carol didn't seem depressed, so he didn't ask.

"When we enter an exam room, we always say, 'Hey, you look great! Look at the baby! Yay!' " said Torie Sepah, a reproductive psychiatrist who has delivered many babies over many years in family practice. "That leaves no room for the mom to not be doing great. To say, 'Actually, I’m really miserable.' "

Women are conditioned to act like they're happy and have it together, Sepah said. To admit otherwise might invite others to believe she's a bad mom, or, worst of all, trigger a call to a government agency that might take the baby away. That's why testing is now required for all new moms, she said, no matter how they present in the doctor's office.

To Sepah, who treated Carol at a Los Angeles jail in the days after her daughters' deaths, there is no doubt she had postpartum psychosis.

Even before the children were killed, Sepah said, there were clinical signs that something was off, in particular, Carol's weight loss: She weighed less after having her third baby than she did before getting pregnant with her first.

After Carol Coronado was arrested, she was taken to a hospital where she was treated for self-inflicted stab wounds and given anti-psychotic medication.
After Carol Coronado was arrested, she was taken to a hospital where she was treated for self-inflicted stab wounds and given anti-psychotic medication. (Evidence file/Compton Courthouse)

What Carol Remembers

That day, Carol was treated briefly in the hospital for a punctured lung, then taken straight to jail. She was on suicide watch for the next 21 months.

That whole time, Carol says she didn't know what was going on or what had happened. The scar, from plunging the knife into her chest? She had no idea how it got there.

It's common for people not to remember what happened during a psychotic episode, said Dr. Sepah. Cognitive pathways short circuit and synapses stop firing correctly: "Instead of going A, B, C, they’re going A, D, G," she said. Those kinds of thought patterns are too disorganized for memories to form.

Carol says her memories stop about a week before the killings.

"That's about the time my brain began to stutter and shut off, memory-wise. Before it completely broke," she says over a scratchy phone connection from prison.

She does remember having nightmares.

"I was terrified to go to sleep. I wasn't showering, taking a bath, brushing my teeth. I wasn't eating. I wasn't doing anything."

She couldn't concentrate. She put socks away in the fridge and milk in the dresser. She felt overwhelmed.

"Like I was worthless, helpless, hopeless and I'd be better off dead," she says. "That nobody needed me. That I was nothing."

Legal Insanity: The Twinkie Defense to Today

Carol was not much help to her defense attorney. At the time, she did not have the insight into her feelings that she is beginning to have now, five years later.

Her lawyer's strategy was an insanity defense. And here the odds were against them: Less than 1% of criminal cases end with a successful insanity defense, according to a seminal study from 1991.

"It's a very, very hard defense to make," said Michelle Oberman, a law professor at Santa Clara University School of Law. "It almost never works in postpartum mental health defenses."

This is because of what happened in 1981, when John Hinckley Jr. fired multiple gunshots in his attempt to assassinate President Ronald Reagan. Hinckley, 25, said he was in love with actress Jodie Foster, and he was convinced that she would fall in love with him if he killed the president.

Psychiatrists said Hinckley had schizophrenia and the jury found him not guilty by reason of insanity. He spent the next 30 years in a psychiatric hospital.

Americans were outraged: The day after the verdict, 83% said justice had not been done. Lawmakers from 38 states rewrote their insanity laws to ensure that another Hinckley "would not get off."

One of them was California. The state had its own version of the Hinckley case a few years earlier in 1978, when Dan White climbed through a window into San Francisco City Hall and shot and killed Mayor George Moscone and Supervisor Harvey Milk.

White's lawyer argued what would from then on be remembered as the infamous "Twinkie defense." He said White suffered from depression, which made him periodically obsessed with junk food, and which compromised his capacity to understand or control what he was doing.

The jury found White guilty of manslaughter, rather than murder, and sentenced him to eight years in prison. San Francisco erupted in riots.

After this, just when the jury delivered the Hinckley verdict, California voters passed a tough-on-crime measure that included an overhaul of the state's insanity defense law.

California is one of 25 states that now uses a strict legal test for insanity established in 1843. It's focused on whether a person knows the difference between right and wrong — it's a moral test, not a clinical one.

"The test for proving insanity is so out of keeping with the way that we understand how the mind works," law professor Michelle Oberman said.

And it completely ignores the risk factors researchers now know are associated with infanticide: isolation and shame. These moms spend long hours alone with their kids with little to no help, Oberman said.

Like a lot of moms, they start to feel like a failure, like a bad mom. But with psychosis in the mix, this belief becomes a full-on delusion. Up to 29% of moms who kill their kids also kill themselves, and even more attempt suicide.

"They start to believe that their children would be better off with them in heaven," Oberman said.

Outside the home of Carol and Rudy Coronado after she killed the couple's three daughters.
Outside the home of Carol and Rudy Coronado after she killed the couple's three daughters. (Evidence file/Compton Courthouse)

The Trial

When Carol Coronado went on trial in 2015, she said she couldn't remember anything from the day her daughters died. And even though this is common with psychotic episodes, it was the biggest weakness in her legal defense.

To be found insane, Carol would have to prove that she didn't know what she was doing was wrong.

But Carol says she didn't know what she was doing at all. She had no explanation for why she did what she did — even a psychotic explanation that her babies would be better off in heaven.

The prosecutor, Emily Spear, exploited this weakness at every turn, filling the void in Carol's memory with her own narrative of what happened. She said Carol's motive was revenge. She said Rudy was a jerk, leaving Carol in charge of three little girls with no help. She said Carol had had enough that day and decided to get back at Rudy by killing their daughters.

"The marriage was not a good one," Spear said during her opening statement. "Finances were very, very tough."

This was a crime of rage, of desperation, but not delusion, she said.

Spear interpreted all of Carol's actions from that day according to this revenge narrative. She framed each move as a premeditated moral failing — while the defense reframed everything as a clinical symptom of psychosis.

The prosecutor pointed to statements Carol gave to a detective hours after she was arrested, when he asked her if she killed her children to "get back at her husband."

She said: "If that’s true, do I get a better deal?" When the detective asked her, "What do you need from us in order to tell us what happened?" Carol responded: "Bedpan."

"A psychotic mind has a logic all its own," said defense expert witness Diana Lynn Barnes. "The state is attempting to use rational, logical thought to explain psychosis, which is illogical and delusional."

This is the thing about postpartum psychosis that most often gets confused in court, she added: the way the symptoms wax and wane.

"Because if one moment I'm telling you something, but then in the next moment I can't remember what I just did – that kind of looks like I'm faking it," Barnes said. "But it’s actually the clinical presentation of postpartum psychosis."

Calm, Just Like Me

When Carol came into the visiting room at the Central California Women's Facility in Chowchilla, she looked — four years after the trial — as she did in the courtroom shot of her that ran in the paper over and over: straight brown hair, a little greasy; pale skin and no makeup.

Carol is getting some treatment here, but it's hard to tell if it's working. Conversation with her jumped around. She easily veered off on tangents. Sometimes she said things that didn't make sense. On other topics, she went deep into detail.

Like the last time her family went to the beach together. Rudy and Sophie went straight for the ocean. But Yazi stayed with Carol. She liked to run her little rake through the sand, look at the lines, then wipe them flat and do it again. Sophie is just like Rudy, social and playful. Yazi is Zen, calm. Just like me, she says.

Some of these stories about the girls still come out in the present tense. Throughout her trial, Carol said she thought her children were still alive.

"I literally kept looking for my children, having delusions that they were on the other side of that door, that they were going to walk in at any moment and I would be able to hold them," she said.

When her family called her in prison and Carol asked after the girls, her mother just said they were "gone." Rudy said they were "safe." Carol figured they were at their godparents' house or her sister's house.

It was her lawyer who told her what happened. The specifics.

"I flipped out. I became hysterical and inconsolable. I was screaming," Carol said. "I did not believe it."

What Carol's case came down to was what the judge believed. She opted for a bench trial, deciding not to take her chances on a jury.

In the end, the judge said he thought Carol did suffer from a mental health condition. He said he believed she needed treatment.

But the insanity law is the law. He said she would have to get treatment in prison. He sentenced her to three consecutive life sentences. No parole.

A Successful Insanity Defense

Angela Burling once stood before a judge like Carol did, after she killed her son. There were a lot of similarities between Angela's case and Carol's, except the outcome: One went to prison, and the other went home.

"I couldn’t have been more fortunate," Angela said from her home outside Sacramento.

In 1983, nine months after Angela gave birth to her second child, Michael, she stopped breastfeeding him abruptly, rather than weaning him gradually as doctors now recommend. She started having strange thoughts.

"I felt I had a calling to expunge the world of evil," she said.

She began to believe her husband, Jeff, was Jesus. She was the bride of Christ. And her baby Michael, was the devil.

"I felt I needed to drown Michael," she said. "But then I thought, 'He’ll come back to life. Jeff will raise him from the dead in three days. Then the world will know: Jeff is Jesus and peace will reign.' So that’s what I did. I drowned him."

This was the thing that made the difference in Angela's case - her account of what happened fit the strict legal test for insanity. She believed her son was the devil and that killing him was the right thing to do.

The judge found her not guilty by reason of insanity. He sentenced her to outpatient treatment, meaning Angela could go home.

Angela recovered. The psychosis went away and Angela has since been doing well taking regular medication for bipolar disorder – doctors now understand women with the disorder have a 30% likelihood of experiencing postpartum psychosis. Women who have had postpartum psychosis with one pregnancy have a 50% chance of having it again with a subsequent pregnancy.

So when Angela became pregnant with her third child, she put together a team of top-notch psychiatric providers to be on call. In their care, she was sure the psychosis would not come back, and even if it did, she was certain no harm would come to her baby.

"When I found out I was pregnant, I was the happiest woman on earth," she said. "Because I felt like, I have another chance – to raise another baby. And prove I'm a good mom."

She went back to school for her master’s degree in nursing, and when her first marriage frayed under the tensions of what happened, she remarried. She and her second husband have been together for 25 years.

"I feel like what happened to me is what should happen to other women in my situation," said Angela, now 64. "I make a case for understanding how it can happen to anybody. I could be your sister, or your daughter, or your wife."

Angela believes the way to level the field for all women is for California to adopt a law similar to Britain's Infanticide Act, which says any woman who kills her baby is presumed to be mentally ill and faces a maximum charge of manslaughter.

Back in 1989, a California senator was so moved by Angela's story that he recommended California adopt a version of this law. But it never went anywhere.

"It was a pretty bold resolution," she said. "I don’t know if society was ready for it then."

Illinois, the one state that has managed to make a small change, now allows judges to give women lower sentences if postpartum mental illness was a factor in her baby's death. For women already convicted, they could get a new hearing and a reduced sentence.

It is the first criminal statute in the U.S. that mentions postpartum psychosis by name. Advocates in Massachusetts, Connecticut and New York are considering a similar law.

If California were to follow suit, KQED's data analysis shows more than 40 women currently in prison could have their cases reheard.

"We can't fail these moms twice," said Joy Burkhard, executive director of 2020 Mom, an advocacy group seeking a sponsor for a similar law in California. "They're failed by the health care system, then again by the legal system."

Rudy Coronado reading a letter from Carol.
Rudy Coronado reading a letter from Carol at his home in October 2018. (April Dembosky/KQED)

‘Speak to the Dads’

Rudy Coronado packs up oil, anti-freeze and wiper blades from his stall at the Alpine Village flea market in Los Angeles. He's been selling auto parts here since his girls were born, about eight years ago.

"I used to want to get rich, to leave something for my daughters. That was my fire, that was my fuel," said Rudy, now 41. "Now, my fire is gone."

He still feels guilty that he didn’t know what was happening to Carol. He still thinks about the way he talked to her or if there was something he could have done to stop it.

So when women's health advocates asked him for help, he said yes. He always says yes. He speaks at rallies and forums and in the state Legislature. His testimony helped pass a package of laws in 2018, including the one requiring mandatory screening of new moms for postpartum mental illness.

Hospitals now also have to train staff how to recognize symptoms, and the state is applying for more federal money to do more outreach to families.

"I always make it an issue to go and speak to the dads," Rudy said of his public appearances. "Because no one never talks to the dads."

He tells them: Postpartum mental illness is real. Look for it. Research it. Don’t confuse it with "baby mama drama."

"This is a famous thing," Rudy explained. " 'Aw, my baby mama’s trippin.' Now I tell them, 'Your baby mama is not trippin. Your baby mama's going through it.' "

The work has helped him to understand what happened to Carol that day, but not necessarily to forgive her.

"The way I think about it, like, I blame the disease, not Carol," he said. "It's not that I forgive Carol. I've kind of, somehow, not really blamed her."

Rudy Coronado reading a letter from Carol.
Rudy Coronado shows a drawing that Carol sent to him from prison in November 2017. (April Dembosky/KQED)

'Should Have Been in a Hospital'

Last October, the Saturday before Carol's 36th birthday, her parents, David and Julie Piercey, got up at 4 a.m. and drove their Dodge minivan five hours north from Los Angeles to the prison in Chowchilla.

In the visiting room with Carol, they didn't say much. They just played round after round of dominoes. Later in the parking lot, they both said Carol doesn't belong here.

"She had no business going to prison," her dad said. "She should have been in a hospital, period."

That's all they wanted from an insanity defense, for Carol to go to a place where she could get real treatment. Not a place where she says other inmates beat her up and call her a baby killer.

Her parents said Carol still says things that don't make sense.

"She tells us, 'I'm going to be getting out in a couple of weeks or three weeks or a month,' " David said. "It's heart-wrenching because I know it's never going to happen."

Her dad can't bring himself to say anything in response. Her mom can’t help but say something.

" 'OK Carol. I'll be happy when you get out, sweetheart!' " she said. " 'Mama’s waiting for you.' "

These conversations are too hard for Rudy. He doesn't visit Carol anymore. He hasn't talked to her on the phone in three years. He said she's not the same person.

Carol still writes to Rudy. He has stacks and stacks of her letters. But he stopped reading those, too. He said she never mentions what happened. She never writes about the girls.

She doesn't even write their names. Just draws cryptic images of threes: three pumpkins, three stars. Three hearts with three letters inside, the girls’ initials: S, Y, X.

April Dembosky is a health correspondent at KQED public radio and The California Report. She is also a recipient of a Rosalynn Carter Fellowship for Mental Health Journalism.

KQED's Kate Wolffe contributed research for this story.


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