Aim. This paper is a report of an analysis of the concept of maternal distress. Background. Although not well-developed, the concept of maternal distress has offered an important viewpoint in nursing and midwifery practice since the mid-1990s. Traditionally, understanding of maternal distress has been based on the medical model and dysfunction. The concept of maternal distress needs development so that it describes responses ranging from normal stress responses to those indicating mental health problem/s. Data sources. The SCOPUS, CINAHL and Medline databases were searched for the period from 1995 to 2009 using the keywords 'psychological distress', 'emotional distress' and 'maternal distress'. Review methods. Steps from Rodgers' evolutionary concept analysis guided the conduct of this concept analysis. Results. Four attributes of maternal distress were identified as responses to the transition to motherhood, with the level of each response occurring along a continuum: stress, adapting, functioning and control, and connecting. Antecedents to maternal distress include becoming a mother, role changes, body changes and functioning, increased demands and challenges, losses and gains, birth experiences, and changes to relationships and social context. The consequences of maternal distress are compromised mental health status, maternal role development, quality of life, ability to function, quality of relationships and social engagement. The extent of the impact depends on the level of maternal distress. Conclusion. Clearer interpretation of maternal distress offers a comprehensive approach to understanding maternal emotional health during the transition to motherhood. Acknowledging women's experiences and providing more appropriate support could alleviate some of the struggles and hardships experienced by mothers.