You're reading this in the dark, phone screen lighting up a quiet room while the baby sleeps. Or maybe you're hiding in the bathroom, just for a minute of peace, because you lost your patience and yelled, and the guilt sits like a physical weight on your chest.
The thoughts won't stop. "I feel like a bad mom." "I miss who I was before all this." "I don't want this baby." "I'm failing at the one thing I was supposed to be good at." Your brain replays every mistake, every cry you couldn't soothe, every moment you felt nothing when everyone said you should feel everything.
This journey to parenthood—whether you're pregnant now or months into postpartum—was supposed to look different. Joyful. Magical. Instead, it feels like your life came to a screeching halt. You feel overwhelmed, disconnected, and deeply, profoundly alone.
If any of this rings true, you need to know something: you are not broken. You are not a bad parent. What you're feeling has a name, and it's the single most common complication of childbirth. It's a medical condition, not a personal failure. And here in San Diego, there's a dedicated network of specialists who understand exactly what you're going through.
This Isn't Just "The Baby Blues"
You've heard about the "baby blues"—those mild mood swings and weepiness that hit in the first two weeks after birth as hormones crash and sleep disappears. The baby blues are real, but they're temporary and usually resolve on their own.
What you might be experiencing is different. Perinatal Mood and Anxiety Disorders (PMADs) are more intense, last longer, and don't get better without support and treatment. The term "perinatal" covers everything from pregnancy through the first year after birth—sometimes longer.
These aren't just one thing. They're a spectrum of treatable conditions that affect up to 20% of pregnant and postpartum people. Let's break down what they actually look like.
Perinatal Depression
This feels like a heavy, persistent cloud of sadness or irritability that strips away your interest in things you used to love. You might feel overwhelming guilt, worthlessness, or hopelessness. It can make it hard to sleep even when the baby is sleeping, or you might want to sleep all the time.
For some, it creates a difficult barrier to bonding with the baby. That doesn't make you a monster—it makes you someone who needs support.
Perinatal Anxiety
Constant, looping worry that you can't turn off. You feel like something terrible is about to happen. Your thoughts race, and you might experience physical symptoms like a pounding heart, shortness of breath, or dizziness.
Panic attacks can feel like you're losing control or even dying, but they're a treatable symptom of anxiety, not a sign that you're actually in danger.
Perinatal Obsessive-Compulsive Disorder
This is one of the most misunderstood and frightening PMADs. It involves intrusive, repetitive, unwanted thoughts or mental images that are often horrific and related to your baby's safety.
You might have terrifying thoughts of harming your baby, even though you have absolutely no intention of acting on them. These thoughts are so against everything you believe that they create intense panic and shame.
In response, you might develop compulsive behaviors to try to reduce the anxiety—constantly checking on the baby, cleaning obsessively, or avoiding being alone with them altogether.
Here's what you need to understand: these thoughts are symptoms of anxiety, not reflections of your true desires. Having them doesn't make you dangerous. It makes you someone whose protective instincts are working overtime in a way that's causing suffering instead of safety.
Postpartum PTSD
This can develop after a traumatic birth experience—an emergency C-section, a NICU stay, feeling powerless and unheard during delivery, or any birth that left you feeling like your life or your baby's life was in danger.
Symptoms include reliving the traumatic event through flashbacks or nightmares, avoiding anything that reminds you of the birth, and feeling hypervigilant or easily startled. Your body remembers the trauma even when your mind tries to move on.
Why This Is Happening to You
If you're struggling, it is not your fault. PMADs aren't caused by anything you did or didn't do. They arise from what experts call a "perfect storm" of factors.
Your body goes through massive hormonal shifts during pregnancy and after birth, which directly affect brain chemistry and mood. A personal or family history of depression, anxiety, or other mental health conditions is one of the strongest predictors, suggesting a genetic vulnerability that gets activated during this high-stress period.
Life circumstances matter enormously. Financial pressure, work stress, a recent move, or conflict in your relationship can strain your ability to cope when you're already stretched thin. A lack of social support—feeling isolated and without your village—is a significant risk factor.
The journey to parenthood itself can be fraught with challenges. A history of infertility, pregnancy or infant loss, a difficult or complicated pregnancy, or a traumatic birth can leave deep emotional wounds. Having a baby in the NICU, having multiples, or being a single, teen, or military parent all come with unique and intense stressors.
For many, this period reactivates past trauma. A history of abuse or difficult childhood experiences can make you more vulnerable to perinatal mental health problems. The intense dependency of an infant and the physical realities of birth can reopen old wounds.
This isn't a sign of weakness. It's a sign that your past is still present, and it deserves compassionate, trauma-informed care.
Your First Call: San Diego's Perinatal Warmline
Making a phone call can feel like climbing a mountain when you're exhausted and overwhelmed. But what if the person on the other end just... gets it?
That's the purpose of the Postpartum Health Alliance (PHA), a San Diego non-profit that has been advocating for parents for over two decades. They're the local go-to resource for perinatal families and professionals throughout San Diego County.
Their most valuable service for someone just starting their search is the PHA Warmline at 619-254-0023. This isn't a crisis line. It's a confidential phone line staffed by trained volunteers who provide peer support, information, and most importantly, personalized referrals to local San Diego therapists and support groups.
The process is designed to be low-pressure. You call the number and leave a message. A volunteer will return your call within 48 hours. You can talk about what you're going through without judgment and get connected to resources that have been vetted by a trusted local organization.
For many San Diego parents, this single call is the first concrete step toward relief.
Integrated Medical and Mental Health Care at UC San Diego
Sometimes mental health care needs to be closely connected with your medical care, especially if you're considering medication or have a complex health history. The UC San Diego Health Women's Reproductive Mental Health Care program is a leading local resource for this kind of integrated support.
This program brings together OB/GYNs, psychiatrists, psychologists, and therapists to create a comprehensive, collaborative treatment plan specifically for you. They're particularly well-suited for managing medication for mood disorders before, during, and after pregnancy, including while breastfeeding.
Their team, led by experts like Dr. Alison Reminick, specializes in helping women navigate everything from infertility and pregnancy loss to postpartum depression and anxiety. Their services include individual, couples, and group therapy, as well as mindfulness and relaxation techniques.
To access the program, you first need a referral from your doctor (like your OB/GYN or primary care physician). Once you have that referral, you can call them directly at 858-534-7792 to make an appointment. This step-by-step process ensures you're connected to the right level of care within a system that understands the deep connection between physical and mental well-being during the perinatal period.
San Diego's Specialized Perinatal Therapists
Finding a therapist is like finding any other important relationship—the right fit matters. When you're navigating the perinatal period, you want someone who doesn't just understand therapy, but who deeply understands this specific life stage.
Look for therapists with PMH-C credentials—Perinatal Mental Health Certified. This means they've completed advanced training in treating PMADs and understand the intricate interplay between hormones, attachment, trauma, and mental health during this period.
San Diego is home to several outstanding therapists and practices that specialize in this work. They know the language, they understand the stakes, and they can hold the complexity of your story.
Flourish Perinatal Therapy
Flourish Perinatal Therapy is led by Karen Del Fierro Monroy, LCSW, PMH-C. Her practice is a sanctuary for parents who have been through the medical wringer.
With years of experience as a clinical social worker in the Neonatal Intensive Care Unit (NICU) at Rady Children's Hospital and at Sharp Mary Birch Hospital for Women & Newborns, she has a profound understanding of medical trauma, high-risk pregnancies, and the unique grief and stress of having a baby in the NICU.
If your path to parenthood has been marked by hospital stays, scary diagnoses, or birth trauma, Karen offers a space of deep empathy and specialized support. She understands the particular kind of exhaustion that comes from living in medical uncertainty and can help you process trauma while still in the thick of ongoing medical care.
Inclusive Reproductive Healing
Inclusive Reproductive Healing was founded on the principle that every reproductive story deserves compassionate, affirming care. Led by Ashley Cardiel, LCSW, PMH-C, this San Diego practice explicitly centers inclusivity and is a safe haven for LGBTQIA+ families, single parents by choice, people using surrogacy or donor conception, and anyone who feels marginalized by traditional healthcare systems.
They specialize in reproductive grief, miscarriage, and infertility, using trauma-informed approaches like EMDR to help you heal. If you're worried that a therapist won't understand your identity or your unique path to parenthood, this is where you can feel seen and safe without having to explain yourself.
Ashley understands that not all reproductive journeys look the same, and that traditional perinatal resources often center heterosexual, cisgender experiences. Her practice creates space for all kinds of families and all kinds of stories.
Bethany Warren, LCSW, PMH-C
Bethany Warren is a leading expert in the San Diego perinatal mental health community with 25 years of experience. She's an author, trainer, and therapist who specializes in some of the most challenging aspects of perinatal mental health.
Bethany is the person to see if you're struggling with perinatal OCD and its terrifying intrusive thoughts. She's trained in Exposure and Response Prevention (ERP), the gold-standard treatment for OCD, and she's also listed in the International OCD Foundation's provider directory.
She's also an expert in treating reproductive and birth trauma using EMDR (Eye Movement Desensitization and Reprocessing). Her practice supports people through infertility, pregnancy loss (including termination for medical reasons), and the secondary trauma experienced by birth workers.
If your symptoms feel particularly scary or complex, Bethany's deep expertise offers a clear, evidence-based path toward healing. She understands that some perinatal mental health conditions require specialized approaches that general therapists simply aren't trained to provide.
What Therapy Actually Looks Like
The idea of therapy can feel intimidating when you're already overwhelmed. You might worry about being judged or forced to talk about things you're not ready to face. The reality is much gentler.
Your first session is simply a conversation. It's a chance for you to share what's been going on and for the therapist to listen without judgment. It's also an opportunity for you to assess whether the therapist feels like a good fit.
Evidence-Based Approaches That Work
Therapists specializing in perinatal mental health use specific, research-backed approaches proven effective for this population.
Cognitive Behavioral Therapy (CBT) helps you recognize and change the negative thought patterns and behaviors that fuel depression and anxiety. Instead of "I'm a bad mom" becoming an accepted truth, you learn to examine the evidence and develop more balanced, realistic thoughts.
Interpersonal Therapy (IPT) focuses on how your relationships and the massive role changes of parenthood are impacting your mood. It helps you navigate conflict, process grief for your pre-baby life, and address social isolation.
For those who've experienced trauma, Eye Movement Desensitization and Reprocessing (EMDR) can be transformative. It's a structured therapy that helps your brain process and integrate traumatic memories—like a difficult birth—so they no longer trigger the same intense fear and anxiety.
The memory doesn't disappear, but it becomes "unstuck" and loses its power to hijack your nervous system. You won't have to relive the trauma in detail over and over.
The Medication Question
Many people fear taking medication during pregnancy or while breastfeeding. This is a valid concern that deserves a thoughtful conversation with knowledgeable providers.
It helps to reframe the decision: untreated maternal depression or anxiety is also an "exposure" for both you and your baby, with its own set of risks. Severe maternal mental health conditions can affect bonding, parenting capacity, and even infant development.
Many medications, particularly SSRIs like Zoloft and Celexa, have been extensively studied and are considered safe, effective first-line treatments during pregnancy and breastfeeding.
The goal is finding the path with the least overall risk for both you and your baby. This decision should be made collaboratively with your therapist, OB/GYN, and potentially a reproductive psychiatrist—like those at UC San Diego Health's Women's Reproductive Mental Health Care program.
Why Specialized Perinatal Care Matters
Not all therapists are equipped to handle the unique complexities of perinatal mental health. You want someone who doesn't just understand therapy, but who deeply understands this specific life stage and its particular challenges.
San Diego's PMH-C certified therapists understand that perinatal anxiety often looks different from general anxiety. They know that postpartum OCD frequently involves intrusive thoughts about harming the baby—and they know how to treat this without shame or judgment.
They're familiar with the specific stressors of NICU stays at Rady Children's or Sharp Mary Birch, breastfeeding challenges, fertility treatments at local clinics, pregnancy loss, and birth trauma. They understand how identity shifts during this transition and can help you grieve who you were while embracing who you're becoming.
Most importantly, they won't minimize your experience or suggest you just need more sleep and self-care. They know this is medical, it's serious, and it's treatable.
Building Your San Diego Support Network
Professional help is crucial, but it's not the only piece of recovery. San Diego offers numerous opportunities to build a network of support—whether that's family, friends, support groups, or online communities.
The Postpartum Health Alliance offers local support groups throughout San Diego County, many facilitated by licensed therapists who combine peer support with psychoeducation. These groups provide face-to-face connection with other parents navigating similar challenges.
Postpartum Support International offers online support groups, chat meetings, and a national helpline (1-944-4PPD-MOMS) staffed by trained volunteers who understand exactly what you're going through.
Local new parent groups, postpartum fitness classes, and mom groups can provide community and practical support. Many San Diego hospitals and birth centers offer new parent support groups that can be a starting point for building connections.
The Reality of Recovery
Recovery from perinatal mental health conditions isn't linear. You might have good days followed by difficult ones. You might feel better for a while, then experience a setback. This is normal and doesn't mean you're failing or that treatment isn't working.
Most people start feeling some relief within a few weeks of beginning treatment, whether that's therapy, medication, or both. Significant improvement typically occurs within 2-3 months, though everyone's timeline is different.
Recovery doesn't mean feeling happy all the time or never struggling with parenting challenges. It means feeling like yourself again—connected to your own thoughts and emotions, able to enjoy moments with your baby, and equipped to handle normal parenting stress without feeling completely overwhelmed.
You'll know you're getting better when the intrusive thoughts lose their power, when you can sleep when the opportunity arises, when you feel genuine moments of joy or contentment, and when you can imagine a future that includes both you and your child thriving.
Taking the First Step in San Diego
The hardest part is often making that initial phone call or scheduling that first appointment. You might worry about being judged, about the cost, about finding time, or about whether you really "deserve" help.
You do deserve help. Your suffering matters. Your recovery matters—not just for you, but for your family. Getting support isn't selfish; it's one of the most generous things you can do for your child.
Start with the Postpartum Health Alliance Warmline at 619-254-0023. One phone call can connect you to the exact resources you need, whether that's a specialized therapist, a support group, or integrated medical care.
If you prefer medical integration from the start, ask your OB/GYN for a referral to UC San Diego Health's Women's Reproductive Mental Health Care program at 858-534-7792.
For those seeking specialized therapy, consider reaching out directly to practices like Flourish Perinatal Therapy, Inclusive Reproductive Healing, or Bethany Warren's practice, depending on what resonates most with your specific needs and identity.
The earlier you seek help, the faster your recovery typically progresses. But it's never too late to get support, whether you're in your second trimester or your second year postpartum.
San Diego has a dedicated community of professionals who understand exactly what you're going through. They know this isn't your fault, they know it's treatable, and they know how to help you feel like yourself again.
You're not broken. You're not failing. You're experiencing something that has a name, a cause, and most importantly, effective treatments available right here in San Diego. Help is closer than you think.