Despite psychotherapists’ pregnancy being a common occurrence with recognised impacts for both clients and clinicians, there remains a dearth of empirical qualitative investigations into the lived experiences of these health professionals. This meta-synthesis therefore aims to generate novel insights and understandings of the experiences of 157 pregnant therapists by integrating the research findings of thirteen qualitative studies exploring the experiences of pregnant and newly post-partum psychotherapists. Utilising Noblit and Hare’s (1988) meta-ethnographic approach, papers were analysed with a view to capturing shared experiences across studies, alongside points of divergence. Analysis led to the development of four key concepts: Identity Changes, Pregnancy necessitates Disclosure, Therapeutic Challenges and Guilt. Pregnancy was related to a multitude of personal and professional challenges, with the impact being most pronounced in the accounts of primiparous, child and trainee therapists. Key clinical implications include the need for continued exploration of the therapeutic impact of pregnancy in both supervision and therapy, revisions to supervisory working practices, prompt disclosure of therapist pregnancy and subsequent reductions to therapeutic fidelity. Future research directions are discussed within.