There is tremendous individual variation in the response to the inherent emotional, psychological and cognitive changes that take place during pregnancy and puerperium, particularly in first-time mothers. Although the psychological changes, particularly in terms of emotional and behavioural changes, have probably been overstated in pregnancy, there are undoubtedly marked changes in such aspects of functioning following delivery. Women should be aware of these changes and be prepared for them, and obstetricians and midwives should incorporate them into their management of patients. All women have valid psychological needs during pregnancy and in the puerperium, and these must be met in order to ensure maternal and infant health and maximum satisfaction with the experience. Antenatal and postnatal care should not result in a struggle for power and control between patient and obstetrician. Emotional reassurance and support can only follow upon adequate information. The best antenatal care and management of delivery requires a spirit of mutual trust and active participation on the part of the patient in the decision-making process. There is ample evidence to support the theory that continuity of care and the continuous supporting role of the midwife, particularly during delivery, exerts a favourable outcome in mothers and children.