Different studies showed a substantially higher rate of different psychological symptoms like PTSD, depression and anxiety in mothers after preterm birth compared with mothers after at term birth. Anyhow lots of mothers stay well and do not develop any symptom after preterm birth. This raises the question, which factors help women to stay well (salutogenous factors) and which factors may support the development of symptoms (pathogenous factors). Little research in this context has dealt with the role of shame and guilt and personal resilience factors like a high sense of coherence. For this reason the medium-term effects of shame and guilt and personal resilience on the outcome of mothers’ adjustment to preterm birth shall be investigated in the current study. This is done in the framework of a multidimensional model for the study of psychological effects of trauma (Maercker, 2003). Aspects of outcome in this study are different psychological symptoms, psychological, physiological and social wellbeing and posttraumatic grow. Grounded in the Personality-System-Interaction-Theory (PSI-Theory, Kuhl, 2001) the functions of different components of shame and guilt and a resilient self-protection-system for the mothers’ adjustment were postulated, tested and discussed. 88 mother after preterm birth before 35 weeks gestational age were asked a few days after preterm birth (T1) and three to four month later (T2, N = 59) in terms of the important variables. Statistical data analyses mainly via regression calculation indicate according to other results in shame and guilt research a substantial dysfunctional effect of shame on mothers’ psychological adjustment, which is partly mediated through the feeling of anger. Feelings of shame and anger mediated in parts the relation between level of trauma intensity and outcome. On the other side there are no or opposing effects of reparation oriented guilt especially related to symptoms of intrusion and hyperarousal (PTSD), which shows an adaptive component of guilt. A resilient self-protection-system in terms of high self determination, low self fragmentation, and a high sense of coherence (SOC) were found to protect against the development of symptoms while high action orientation showed functional effects in relation to psychological and social wellbeing. The cross-sectional data supported the postulated mediation of the relation between self-protection-system and outcome through feelings of shame and anger, whereas longitudinal data support an independent impact of shame and guilt on the one side and personal resilience on the other. There were only little results in relation to posttraumatic grows. Clinical implications of results and consequences for further research are discussed.