You're supposed to be glowing. Nesting. Folding tiny clothes with joy and counting down the days until you meet your baby. Everyone keeps telling you this is the most beautiful time—these final, precious weeks before everything changes.
But that's not how you feel.
Instead, you feel broken. Numb. When you look in the mirror, you don't see a radiant mother-to-be. You see a stranger who can barely get through the day. Cooking a meal feels impossible. You've let the chicken go bad in the fridge again because making dinner is too much. The bath crayon has been stuck on the tub for a month because scrubbing it off requires energy you don't have.
A heavy guilt settles in your chest. "I should be happy," you tell yourself. "What's wrong with me?" You love your baby—of course you do. But a quiet, terrifying thought whispers in the back of your mind: "I'm not cut out for this." Or worse: "They would be better without me."
If this is you, please hear this: You are not broken. You are not failing. What you're feeling is real, valid, and treatable. You're experiencing something that affects up to 20% of pregnant people, and it has a name: prenatal depression.
At Phoenix Health, our therapists understand exactly what you're going through because they specialize in perinatal mental health. This isn't just hormones or third-trimester mood swings—it's a legitimate medical condition that deserves care.
This Isn't Just "Pregnancy Emotions"
It's easy to dismiss what you're feeling. Pregnancy brings massive hormonal shifts, and mood swings are part of the package. But there's a crucial difference between occasional tearfulness and the persistent weight of clinical depression.
Prenatal depression can strike at any point during pregnancy, but research shows it often follows a V-shaped curve—highest in the first and third trimesters. One study found that 21% of women screened in the third trimester showed symptoms of depression, compared to 17% in the second trimester.
This isn't a coincidence. The third trimester creates a perfect storm: your body is under immense physical strain, hormones are at their highest levels of the entire pregnancy, and the abstract idea of "having a baby" suddenly becomes the very real, very imminent reality of labor and caring for a newborn.
The difference between normal pregnancy challenges and prenatal depression isn't just about what you're feeling—it's about how those feelings impact your ability to function and find any joy in your life.
What Prenatal Depression Actually Looks Like
Normal pregnancy mood swings come and go. Prenatal depression sticks around. According to the National Institute of Mental Health, symptoms need to be present for at least two weeks to qualify as a major depressive episode.
You might experience:
A persistent sad, anxious, or "empty" mood that doesn't lift, no matter what you do. It's not just being down for a day—it's a heaviness that colors everything.
Loss of interest in things you used to enjoy (clinically called anhedonia). The hobbies, foods, or people that once brought you joy now feel flat and uninteresting.
Feelings of hopelessness, worthlessness, or excessive guilt. You blame yourself for things that aren't your fault or feel like a complete failure at everything.
Intense irritability or restlessness. It's more than being "cranky"—it's feeling constantly on edge or easily angered over small things.
Profound fatigue that goes far beyond normal pregnancy exhaustion. It's a bone-deep weariness that sleep doesn't touch.
Sleep disruption that's worse than typical third-trimester discomfort. You might lie awake for hours with racing thoughts, even when exhausted, or find it impossible to get out of bed.
Significant appetite changes leading to poor weight gain or excessive weight gain.
Trouble concentrating, remembering, or making decisions. This feels like severe "pregnancy brain" that makes even simple tasks overwhelming.
Poor attachment to the baby. You might feel detached from the pregnancy or have persistent doubts about your ability to care for your baby.
Thoughts of death, suicide, or harming yourself or the baby. These thoughts are terrifying but they're a symptom of the illness, not a reflection of who you are.
If you're having thoughts of harming yourself or your baby, please seek immediate help. Call or text 988 for the Suicide & Crisis Lifeline.
Why Now? The Perfect Storm of Late Pregnancy
It can feel confusing for depression to hit when you're so close to the finish line. But the third trimester creates unique pressures that converge all at once.
Physically, your body is maxed out. Back pain, swelling, heartburn, and profound discomfort make sleep feel like a distant memory. Hormonally, you're coursing with the highest levels of estrogen and progesterone of your entire pregnancy, which significantly impacts brain chemistry and mood.
Psychologically, the abstract becomes concrete. "Having a baby" transforms into the imminent reality of labor and the overwhelming responsibility of caring for a newborn. The waiting itself—not knowing when labor will start—becomes a significant source of stress.
Socially, the pressure to be happy feels suffocating. Your physical limitations make it harder to connect with others, creating isolation right when you need support most.
This potent combination creates the perfect environment for depression and anxiety to take hold.
The Anxieties That Keep You Up at Night
Third-trimester depression rarely travels alone. For many, it's deeply intertwined with anxiety. As your due date approaches, abstract worries sharpen into specific, consuming fears.
The Terror of Giving Birth
Feeling nervous about labor is completely normal. But for some, this escalates into tokophobia—an intense, debilitating fear of childbirth that goes far beyond typical pre-birth jitters.
This isn't just nerves. It's a pathological condition that can cause overwhelming distress, panic attacks, and avoidance behaviors. The fear might stem from terror of unbearable pain, losing control, medical interventions, or injury or death for you or your baby.
If you've had a previous traumatic birth, you might be experiencing secondary tokophobia—a form of PTSD where the prospect of giving birth again triggers memories of past trauma.
Tokophobia can make you feel completely disconnected from your pregnancy. You might avoid conversations about birth, refuse to pack a hospital bag, or feel an overwhelming urge to request a C-section even without medical need.
This fear is real and powerful. Specialized therapy can provide tools to manage it and approach birth with more confidence.
The Fear of Who You'll Become
Beyond birth itself lies another profound anxiety: fear of the person you'll become afterward. The transition to motherhood is one of the most significant identity shifts anyone can experience.
It's common to grieve the life you're leaving behind and panic about losing yourself completely. "I miss who I was" or "Will I ever feel like myself again?" are refrains many struggling with prenatal depression know well.
This anxiety intensifies under the pressure to be a "good mother." You might doubt your ability to care for a baby, fearing you won't know what to do or that you'll make terrible mistakes.
You might worry about your relationship changing—becoming disconnected from your partner under the weight of new responsibilities and sleep deprivation.
Perhaps most painful is the fear that you won't bond with your baby—that you'll feel nothing but emptiness or resentment. This is a common symptom of perinatal depression. Feeling detached from your baby doesn't make you a monster; it makes you someone who needs support.
The Constant Worry That Something Is Wrong
Perinatal anxiety often manifests as relentless worry that something terrible will happen. Your brain gets stuck in a loop of catastrophic what-ifs.
You might lie awake at night, heart pounding, convinced that a movement you felt (or didn't feel) signals something wrong with your baby's health.
This hypervigilance is exhausting. It leads to obsessive behaviors like constantly checking for fetal movement or falling down rabbit holes of online searches—a form of "doomscrolling" that only fuels anxiety.
These intrusive thoughts and feelings of dread aren't your intuition. They're symptoms of an anxiety disorder hijacking your brain's protective instincts and turning them against you.
At Phoenix Health, our perinatal mental health specialists understand these fears intimately and can help you quiet the noise to find safety again.
You Don't Have to Power Through
The most important thing to know: you don't have to endure this alone. Prenatal depression and anxiety are highly treatable. Reaching out for help is the strongest, most loving thing you can do for yourself and your baby.
The path to feeling better isn't about "powering through" or "toughing it out." It's about acknowledging you need support and taking the first step to get it.
Start with Your Doctor
Having a conversation about your mental health can feel intimidating, but your healthcare provider is crucial first-line support. The American College of Obstetricians and Gynecologists recommends that all pregnant people be screened for depression and anxiety at least once during pregnancy, often during a third-trimester visit.
Your doctor is expecting this conversation and prepared to help.
You don't need perfect words. It can be as simple as: "I've been feeling really down and anxious lately, and I'm worried it's more than normal pregnancy feelings" or "I'm not enjoying things anymore, and I'm having a hard time getting through the day. Can we talk about it?"
Your provider will likely ask you to complete a short screening questionnaire like the Edinburgh Postnatal Depression Scale (EPDS). This isn't a test you can pass or fail—it's a tool to start the conversation and understand your symptoms more clearly.
Being honest is the best way to get the help you need. Learn how to talk to your doctor about your mental health during pregnancy with specific language that can help guide the conversation.
Therapy That Actually Understands Pregnancy
Therapy is one of the most effective, evidence-based treatments for prenatal depression and anxiety. But working with a therapist who specializes in perinatal mental health makes all the difference.
These specialists deeply understand the unique challenges of this life stage. They won't dismiss your feelings as "just hormones" or suggest you'll feel better once the baby arrives. They know that not being a bad mom and struggling with mental health aren't mutually exclusive.
Two of the most effective approaches are:
Cognitive Behavioral Therapy (CBT) helps you identify, challenge, and change negative thought patterns and behaviors that fuel depression. A therapist can help you work through thoughts like "I'm going to be a terrible mother" and replace them with more balanced, compassionate self-talk.
Interpersonal Therapy (IPT) focuses on your relationships and social support systems. It helps you navigate relationship challenges, process grief or loss, and build a stronger support network for this transition.
The difference between general therapy and perinatal mental health specialty is significant. A therapist with advanced certification in perinatal mental health (PMH-C) has completed extensive training specifically in pregnancy, postpartum, and fertility-related mental health challenges. They understand the unique intersection of hormones, identity shifts, relationship changes, and the specific fears that arise during this time.
This isn't just about having someone to talk to—it's about working with someone who has dedicated their practice to understanding exactly what you're experiencing.
The Question of Medication
The thought of taking medication during pregnancy can be scary. There's a lot of fear and misinformation around antidepressants, but it's essential to weigh small potential risks against the very real, well-documented risks of untreated depression.
Untreated prenatal depression increases risk of preterm birth, low birth weight, and complications after delivery. It also significantly increases your risk of developing postpartum depression.
For your baby, untreated maternal depression can affect their stress response systems and long-term emotional and cognitive development.
Many antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs), are considered safe during pregnancy and have been studied extensively. Medications like sertraline (Zoloft) and citalopram (Celexa) are often first-line treatments because of their strong safety profiles.
The decision to take medication is personal, made in collaboration with your doctor. They can help you understand benefits and risks so you can make an informed choice that's right for you and your baby.
Small Steps You Can Take Right Now
While exploring professional support, there are gentle things you can do to help manage symptoms and ground yourself. These aren't cures, but they can provide moments of relief and help you feel some control when everything feels chaotic.
Practice mindful breathing. When anxiety rises, your breath is your most powerful anchor. Try this: Place one hand on your chest, the other on your belly. Inhale slowly through your nose for four counts, feeling your belly expand. Hold briefly. Exhale slowly through your mouth for six counts, feeling your belly fall. Repeat for a few minutes. This simple act can calm your nervous system.
Try short meditations. Your mind might be racing, but you can find quiet moments. Guided meditations for pregnancy and postpartum anxiety are specifically designed to address fears of this period. Even five minutes makes a difference.
Journal with self-compassion. Writing down feelings can be powerful release. You don't need to write a novel—just get thoughts out of your head onto paper. Try gentle pregnancy journal prompts for anxiety like: "What is one fear I can acknowledge today?" or "What is one small thing I can do to be kind to myself right now?"
Build your support circle. You weren't meant to do this alone. Reach out to one trusted person—your partner, a friend, family member—and tell them you're struggling. Let them know what you need, whether it's a listening ear or practical help.
Share resources on how partners can help support you or look into online support groups for pregnant and postpartum moms. Organizations like Postpartum Support International offer invaluable resources and peer support.
The Reality of Recovery
Recovery from prenatal depression isn't linear. There will be good days and harder days. The goal isn't to feel perfect or perpetually happy—it's to feel more like yourself and develop tools to manage the challenging moments.
Many people worry that addressing their mental health during pregnancy somehow makes them weak or selfish. The opposite is true. Taking care of your mental health is one of the most important things you can do for your baby. Research consistently shows that maternal mental health directly impacts infant development, bonding, and long-term outcomes.
When you feel better, you're better able to bond with your baby, make decisions about your birth preferences, and prepare for the postpartum period. You're also significantly less likely to develop postpartum depression if prenatal depression is properly treated.
The shame and isolation that often accompany prenatal depression can make it feel like you're the only one struggling. You're not. Feeling sad during pregnancy can be normal, but when that sadness becomes persistent and interferes with your daily life, it's time to seek support.
Understanding Pregnancy Brain vs. Depression
One challenge in recognizing prenatal depression is that some symptoms overlap with normal pregnancy experiences. "Pregnancy brain"—that foggy, forgetful feeling—is real and well-documented. But when cognitive difficulties become severe enough to impact your ability to work, make decisions, or remember important things, it might signal something more serious.
The same applies to fatigue. Third-trimester exhaustion is universal, but depression-related fatigue feels different. It's not just being tired after a long day—it's waking up already exhausted, feeling like simple tasks require enormous effort, and having no energy even for things you normally enjoy.
The key difference is severity and persistence. Normal pregnancy challenges come and go. They might be frustrating or uncomfortable, but they don't fundamentally change how you see yourself or your future. Prenatal depression does.
The Specialized Care Difference
General therapy can be helpful, but perinatal mental health specialists offer something different. They understand that your concerns about overcoming tokophobia with therapy aren't just generic anxiety—they're specific fears rooted in the reality of approaching childbirth.
They know how to help you create a birth plan that honors your fears while building confidence. They understand that your worry about bonding with your baby isn't just general relationship anxiety—it's a specific concern that emerges from the unique psychology of becoming a parent.
At Phoenix Health, our therapists complete extensive training in perinatal mental health certification (PMH-C). This means they've studied the specific ways mental health intersects with pregnancy, birth, postpartum adjustment, fertility challenges, and pregnancy loss. They understand the hormonal influences on mood, the psychology of identity transition, and evidence-based treatments that are safe and effective during pregnancy.
This specialization matters because the stakes are higher and the timeline is compressed. You don't have years to work through these issues—your baby is coming soon. You need someone who can quickly understand your specific situation and help you develop coping strategies that work both now and after birth.
Managing Expectations About Birth and Beyond
One source of third-trimester anxiety is the pressure to have a perfect birth experience and immediately feel overwhelming love for your baby. Social media, movies, and well-meaning friends can create unrealistic expectations that set you up for disappointment and self-criticism.
The reality is messier and more varied. Some people feel instant connection with their babies; others need time to develop that bond. Some births go according to plan; others require flexibility and adaptation. Some people feel immediate joy after birth; others feel relief, exhaustion, or even temporary sadness.
None of these variations make you a bad parent. They make you human.
Working with a perinatal mental health specialist can help you develop realistic expectations and coping strategies for various scenarios. They can help you understand that struggling with mental health during pregnancy doesn't predict your experience as a parent or your ability to bond with your baby.
The Ripple Effects of Untreated Depression
While it's important not to catastrophize, understanding the potential consequences of untreated prenatal depression can motivate you to seek help. Beyond the immediate suffering you're experiencing, untreated depression can:
Increase your risk of pregnancy complications, including preterm birth and low birth weight. Affect your baby's stress response systems and emotional regulation. Significantly increase your likelihood of developing postpartum depression. Impact your ability to make informed decisions about your birth and early parenting. Strain your relationships at a time when you need support most.
These aren't meant to scare you but to reinforce that treating prenatal depression isn't selfish or optional—it's essential healthcare for both you and your baby.
Building Your Postpartum Mental Health Plan
Part of treating third-trimester depression involves preparing for the postpartum period. The transition after birth brings its own challenges: hormonal crashes, sleep deprivation, physical recovery, and the reality of caring for a newborn.
Having a mental health plan in place before birth can make this transition smoother. This might include:
Continuing therapy through the postpartum period. Having contact information for perinatal mental health resources readily available. Discussing postpartum depression risk factors with your healthcare provider. Building a support network that can help with practical needs after birth. Understanding warning signs that might indicate you need additional support.
If you're already working with a perinatal mental health specialist during pregnancy, they can help you prepare for this transition and ensure continuity of care.
The Courage to Ask for Help
Perhaps the hardest part of dealing with third-trimester depression is overcoming the shame and fear that prevent you from asking for help. You might worry that admitting you're struggling makes you seem ungrateful or unfit to be a parent. You might fear that seeking mental health treatment will somehow be documented and used against you.
These fears are understandable but largely unfounded. Seeking mental health care during pregnancy is increasingly common and widely supported by medical professionals. It's seen as responsible self-care, not a red flag.
You might also worry about the time and energy required for treatment when you already feel depleted. But the energy you're spending on managing depression and anxiety on your own is enormous. Professional support can actually reduce the mental load you're carrying.
The courage to ask for help doesn't feel courageous in the moment—it often feels scary and vulnerable. But it's one of the bravest things you can do, both for yourself and for your baby.
You're Not Broken
This is hard. You don't have to pretend it isn't. You're carrying so much, both physically and emotionally. The guilt, the fear, the exhaustion—it's all real, and it's all valid.
But you're not broken. You're not failing. You're experiencing a treatable medical condition during one of the most challenging periods of human experience.
The voice in your head telling you that you're not cut out for this, that your baby would be better off without you, that you're somehow fundamentally flawed—that's not your voice. That's depression talking. And depression lies.
Your baby needs you. Not a perfect version of you, not a constantly happy version of you, but you. The real you, who loves fiercely even when struggling, who shows up even when it's hard, who seeks help when needed.
You don't have to carry this alone. Phoenix Health specializes in exactly what you're going through, and we're here when you're ready.