This study examined whether particular groups of psychotic women are likely to present management problems during pregnancy and childbirth. The pregnancy courses and outcomes of 22 psychiatric inpatients were reviewed. Schizophrenic women with delusions or psychotic denial about the pregnancy were significantly less likely to detect labor than were nondelusional women. Ability to detect signs of labor and cooperate with labor instructions was significantly more likely in women with bipolar affective disorders than in those with schizophrenic disorders, and was also more likely in those women with severe personality disorders and substance abuse histories. The total patient cohort underwent significantly more cesarean sections than their nonpsychiatric counterparts who delivered at the same hospital. These findings suggest that psychotic women are at high risk for the development of pregnancy and birth complications.