A judge has again told the deadlocked jury in Lindsay Clancy's murder trial to keep trying to reach a verdict after a dramatic sixth day of deliberations in a case that has gripped America.

Tensions flared in court after the jury forewoman sent the judge a note saying one juror would not follow the judge's instructions on reasonable doubt.

There was audible shock in the room when the defence team asked for the juror to be removed, a request that was denied by the judge.

Clancy, 36, is charged with three counts of first-degree murder in the deaths of her three children - Cora, five, Dawson, three, and eight-month-old Callan - at her Massachusetts family home on 24 January 2023.

Warning: This article contains distressing details

The former labour and delivery nurse does not deny strangling her two sons and daughter in the basement of their house.

But her lawyer argues she was suffering from postpartum psychosis at the time, and could not distinguish right from wrong.

The jury of nine women and three men in Plymouth has deliberated for some 35 hours without a verdict, following nearly six weeks of trial proceedings.

The panel has twice previously sent the judge notes saying it could not come to a unanimous decision, but Thursday was the first hint of rancour in the deliberation room.

Clancy's lawyer, Kevin Reddington, said in court that the jury forewoman had sent another note, this one complaining to Judge William Sullivan that a juror was refusing to listen to the law on reasonable doubt.

Reddington and prosecutor Jennifer Sprague had an animated discussion with the judge in court.

Reporters in the room could not hear the exchange, but the BBC saw exasperated facial expressions and gestures from Clancy's lawyer.

Reddington then went over to Clancy to explain what had just happened, in what seemed to be a tense conversation.

Clancy, who was paralysed from the waist down when she jumped out of a second-floor window after killing her children, was pushed in her wheelchair by her lawyer to join a discussion with the judge.

Afterwards, Judge Sullivan brought in each juror individually and questioned them.

He reminded the panel they must unanimously believe beyond reasonable doubt that the defendant is guilty in order to convict her of a crime. As each juror came up, some looked at Clancy, while others did not.

When the defence lawyer told the court about his request to have a juror removed, there were gasps and reporters quickly began typing.

Judge Sullivan said the holdout juror could stay and deliberations could continue.

"I don't feel it is proper for me to side with one side or the other of the deliberations," the judge said.

Sprague, the prosecutor, said the judge's instructions to the jurors were appropriate.

"There's no way to determine what the deliberations are, who's correct, who's incorrect, nor should we attempt to," she said.

Clancy bowed her head as the media begin to exit the room.

Reddington, looking upset, could be seen consoling his client, holding her in a side hug and rubbing her back as journalists left court.

The defence lawyer told reporters afterwards that the forewoman's note to the judge stated that there was one holdout in the jury who, as he described it, "refuses to listen to the law... on reasonable doubt".

Reddington said he had suggested to the judge "a motion to remove the juror who refuses to accept your instructions on the law on a reasonable doubt".

The defence lawyer said he had no indication of what this lone juror was thinking and he did not confirm the 11-1 split the jury forewoman reported earlier.

The issue with the juror is expected to be addressed again when court convenes at 09:00 EST (14:00 BST) on Friday.

If the jury does not reach a verdict and Judge Sullivan declares a mistrial, prosecutors would need to decide whether to retry the case.

Clancy faces life in prison without parole if convicted of first-degree murder.

If found not guilty by reason of lack of criminal responsibility, or reason of insanity, she could be committed to a state psychiatric hospital.

Under US law, a jury must unanimously believe "beyond a reasonable doubt" that someone is guilty in order to convict them of a crime.

The designation is the strictest standard in the US legal system. It places the burden on the government to prove that the accused is guilty, and not the accused to prove their innocence.

If you are suffering distress or despair and need support, you could speak to a health professional, or an organisation that offers support. Details of help available in many countries can be found at Befrienders Worldwide. www.befrienders.org.

In the UK a list of organisations that can help is available at bbc.co.uk/actionline.