The transformation of women into mothers is both a psychic and a physical development. Although the focus of psychodynamic psychotherapy is on the internal, psychic world, a therapist working with pregnant women and new mothers may also need to deal with serious problems in the external, physical world. For instance, what approach is most helpful for a young woman who smacks her baby of 10 months, while also struggling with rage at her own mother's abandonment of her? This paper describes how psychodynamic and cognitive ideas and techniques have been combined to resolve this clinical dilemma. Lessons have been drawn from the integrated approach developed by psychodynamic practitioners working with a different patient group, that of borderline personality disorder, since such patients often present in crisis, as do pregnant women and new mothers. I worked with 76 patients in Maternity and Gynaecology in a London hospital over an 18-month period and three cases are described in detail in this paper.