Aims: The perinatal period is arguably one of the most important life stages in which the accurate detection and treatment of psychological distress is required. Perinatal depression, anxiety and trauma affect approximately one-third of women in Australia. Our past research has shown that one-third of women experience traumatic events associated with childbearing. Furthermore, few women attend referrals to mental health practitioners. We conducted a randomized control trial to determine the effect of midwifery-led trauma focused counselling with postnatal women to prevent and treat emotional distress. Method: 1038 women were recruited from two locations in Australia, during the last trimester in pregnancy. Women reporting a distressing birth experience were randomised to receive trauma focused counselling (intervention) or parenting advice (active control). The intervention group and active control group were contacted by midwives during the first and sixth week postpartum. Midwives received specific training and supervision. Results: Women experiencing perinatal distress associated with traumatic birth and receiving trauma counselling by midwives reported improved mental health outcomes. They reported significantly fewer symptoms of depression, better social support and adjustment to motherhood. Conclusions: Perinatal mental health initiatives have focused on the psychosocial assessment of women with limited attention to facilitating access to mental health support. Training midwives with advanced skills in counselling to address perinatal distress holds promise for integrating mental health care into maternity services thereby providing professional support to treat or prevent distress for the majority of women in need.