Unintended childbearing is associated with poorer parental well-being, but most scholarship in this area takes an individual-level approach to unintended childbearing. Drawing on couple data from the Early Childhood Longitudinal Study–Birth Cohort (ECLS-B), I treat unintended childbearing as a couple-level construct to provide a more comprehensive understanding of how individuals’ intentions, partners’ intentions, and gender are linked with psychological distress in the transition to parenthood. I make two chief contributions to prior research. First, the inclusion of fathers’ perspectives provides an important addition to research, which primarily focuses on mothers’ unintended childbearing. Second, I assess gender differences in the association between couples’ intentions and health. For mothers, one’s own intentions appeared most closely tied to distress regardless of the father’s intentions, whereas fathers reported more depressive symptoms if either parent did not intend the birth. Formal post-estimation tests of differences in the magnitude of coefficients for mothers and fathers suggest few gender differences exist in the association between couples’ intentions and psychological distress. For mothers and fathers alike, belonging to a couple where neither parent intended the birth was consistently associated with the highest levels of distress. Implications for policy and research are discussed in relation to findings.