This prospective qualitative study examined patterns of family adaptation over 4 years following the birth of a first child. Data were collected on 16 first-time mothers during their second trimester of pregnancy, at 4 months, 1 year, and 4 years after the birth of the infant. Both standard measures and an intensive semistructured interview were used to assess change in women's perceptions of marital adaptation and role reorganization. Using a case-study method, data were analyzed for patterns of family adaptation. Interview data showed that marital distress and later family disorganization patterns were related, in part, to the changes in the marital system starting during the early transition to parenthood, suggesting that subjects' negative perceptions of marital satisfaction as early as 4 months postbirth forecasted later family adjustment problems. Socioeconomic stress and substance use was associated with the changes for some of these subjects. Alternative interpretations and future directions for study are discussed. The study was funded partially by the National Institute of Mental Health, Juvenile Research Division Grant No. 5 R01 MH27333-02 to Patricia S. Tomlinson and USPHS traineeship grant no. All NU 00250-02 Barbara Irwin.