Perinatal Experiences Research Articles

An Exploratory Qualitative Study of Perinatal Experiences in an Acute Setting during Early Phases of the COVID-19 Pandemic

An Exploratory Qualitative Study of Perinatal Experiences in an Acute Setting during Early Phases of the COVID-19 Pandemic

Weight-based disparities in perinatal care: quantitative findings of respect, autonomy, mistreatment, and body mass index in a national Canadian survey

BackgroundQualitative studies document episodes of weight-related disrespectful care, particularly for people with high body mass index (BMI ≥ 30) and reveal implicit and explicit biases in health care providers. No large quantitative studies document the pervasiveness of weight stigma or if experiences change with increasing BMI.MethodsThe multi-stakeholder RESPCCT study team designed and distributed a cross-sectional survey on the experiences of perinatal services in all provinces and territories in Canada. From July 2020 to August 2021, participants who had a pregnancy within ten years responded to closed and open-ended questions. Chi square analysis assessed differences in mean scores derived from three patient-reported experience measures of autonomy (MADM), respect (MOR), and mistreatment (MIST). Controlling for socio-demographic factors, multivariate logistic regression analysis explored relationships between different BMI categories and respectful care.ResultsOf 4,815 Canadians who participated, 3,280 with a BMI of ≥ 18.5 completed all the questions. Pre-pregnancy BMI was significantly associated with race/ethnicity, income sufficiency, and education but not with age. Individuals with higher BMIs were more likely to experience income insufficiency, have lower levels of education, and more frequently self-identified as Indigenous or White. Those with BMI ≥ 35 exhibited notably higher odds of reduced autonomy (MADM) scores, with an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 compared to individuals with a normal weight. Individuals with BMIs of 25–25.9, 30–34.9, and ≥ 35 exhibited odds of falling into the lower tercile of respect (MOR) scores of 1.34, 1.51, and 2.04, respectively (p < .01). The odds of reporting higher rates of mistreatment (top 33% MIST scores) increased as BMI increased.ConclusionsWhile socio-demographic factors like race and income play significant roles in influencing perinatal care experiences, BMI remains a critical determinant even after accounting for these variables. This study reveals pronounced disparities in the provision of respectful perinatal care to pregnant individuals with higher BMIs in Canada. Data suggest that those with higher BMIs face disrespect, discrimination, and mistreatment. Identification of implicit and explicit weight bias may give providers insight enabling them to provide more respectful care.

Prenatal exercise and its effects on postpartum mental health: systematic review and meta-analysis.

The perinatal period, spanning from pregnancy through the first year after childbirth, is characterized by significant physiological, psychological, and socio-contextual changes. Women face complex stressors including psychosocial pressures, financial constraints, interpersonal dynamics, anticipatory stress related to parenthood, hormonal fluctuations, and societal expectations. These factors collectively influence the perinatal experience, increasing vulnerabilities and stress levels. A systematic review was conducted in October 2023 using PubMed, SPORTDiscus, PsycInfo, and Scopus databases. Only English-language publications were included. For the meta-analysis, only randomized controlled trials (RCTs) using the Edinburgh Postnatal Depression Scale (EPDS) were considered. Data extraction was performed independently by two reviewers using Covidence, focusing on study characteristics, population demographics, interventions, and outcomes. The initial search identified 2,373 articles, with 1,196 duplicates removed, leaving 1,177 articles. After screening titles and abstracts, 1,247 were excluded for not meeting the inclusion criteria, resulting in 30 full-text articles reviewed for eligibility by two researchers. Nineteen studies were included in the systematic review, with four in the meta-analysis. Results indicated that higher levels of physical activity during pregnancy were consistently associated with improved postpartum mental health outcomes, including reduced depressive symptoms, lower anxiety, and enhanced overall well-being. Low-intensity exercises, such as yoga, were particularly effective in reducing postpartum depressive symptoms. The impact of moderate-intensity exercise varied, with some studies showing no significant effects. The meta-analysis of four RCTs using the EPDS demonstrated a significant reduction in depression and anxiety symptoms among postpartum women who participated in physical activity interventions, with a substantial overall effect size. Developing physical activity and exercise regimens encompassing a range of intensities can address the unique physiological and psychological demands of the perinatal period, maximizing the therapeutic benefits of physical activity interventions.

Polycystic ovary syndrome: Fertility, prenatal care, pregnancy, and postpartum care.

Polycystic ovary syndrome (PCOS) is a complex, heterogeneous reproductive endocrinopathy affecting 8% to 13% of women in their reproductive years. PCOS has a vast array of clinical manifestations, including metabolic complications, biochemical and phenotypical hyperandrogenism, menstrual cycle dysfunction, and anovulation resulting in infertility. Understanding the relationship of the disorder's pathophysiologic and clinical manifestations is key to successfully managing patients with PCOS. Patients may have different prenatal, perinatal, and postnatal experiences than those who do not have PCOS, and may require a higher level of care or treatment plan adjustments.

Wait, What? What's Going On?- Pregnancy Experiences of Deaf and Hard of Hearing Mothers Who Do Not Sign.

Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care. Qualitative study using thematic analysis. Semi-structured, individual remote, or in-person interviews in the United States. Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years. Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. The barriers and facilitators related to a positive perinatal care experience among DHH women. Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences. Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.

Perinatal Support from Chinese Fathers in Australia

Ineffective perinatal support can leave women susceptible to poorer health outcomes. Fathers today are expected to provide perinatal support. However, many feel hesitant on how to provide optimal support and Chinese fathers navigate this with additional social and cultural expectations. The aim of this paper was to describe the perinatal support experiences of Chinese fathers in Australia. Ten Chinese men were interviewed. Qualitative Descriptive Methodology and Thematic Analysis were used. Results: Fathers adapted their support to meet their partners’ changing perinatal requirements and healthcare providers influenced their ability to do so. Postnatally, fathers were guided by Chinese cultural practices.

Exploration of fathers’ mental health and well-being concerns during the transition to fatherhood, and paternal perinatal support: scoping review

ObjectivesTo appraise and synthesise qualitative literature identifying: (a) fathers’ concerns and challenges during the transition to fatherhood that may be impacting mental health and well-being experiences; and (b) fathers’ experiences...

Risk of Developmental Delay in Infants Born to Perinatal COVID-19-Positive Mothers at a Tertiary Care Hospital: A Cross-Sectional Study

Purpose: Prenatal and perinatal experiences of the mother are known to influence infant development. Maternal exposure to coronavirus disease 2019 (COVID-19) during pregnancy has been associated with increased morbidity and mother-baby separation. However, the developmental outcomes of infants born to COVID-19-positive mothers remain unclear. This study represents an initial exploratory effort to assess the developmental risks faced by infants born to mothers who tested positive for COVID-19. Methods: This cross-sectional study involved telephonic interviews and developmental screenings of 45 infants, aged 9 to 15 months, who were born to perinatal COVID-19-positive mothers between July 2020 and May 2021. The Ages &amp; Stages Questionnaire was used for the developmental assessment. The impacts of maternal, infant and separation-related factors on development were analyzed. Results: Within the study population, 28.8% (13 of 45 infants) presented with a risk of developmental delay. The gross motor and problem-solving domains were the most frequently impacted. Among the factors studied, prolonged separation period (exceeding 7 days), advanced maternal age, and gestational age (preterm birth) were associated with higher proportions of infants at risk of developmental delay; however, these associations were not statistically significant.Conclusion: This study suggests that infants born to mothers who tested positive for COVID-19 during the perinatal period face a risk of developmental delay. Factors such as maternal age, gestational age at birth, metabolic disease during pregnancy, and infant-mother separation could exacerbate this risk. Future research should prioritize objective assessments of development and long-term follow-up to monitor developmental outcomes in this population.

Midwives’ perspectives and perceptions in relation to perinatal psychotic-like experiences: a qualitative study

ABSTRACT Background Psychotic-like experiences (PLEs) refer to subclinical experiences consistent with psychosis that may include hearing, feeling or seeing things that others cannot, or experiencing unusual beliefs. These experiences appear to be more common during the perinatal period. There appear to be barriers which make it difficult for midwives to support mothers with mental health difficulties. However, it is important that midwives can provide support with PLEs. Aim This study aimed to explore UK midwives’ perspectives and perceptions relating to mothers’ psychotic-like experiences in the perinatal period. Methods A qualitative study using semi-structured interviews with ten midwives recruited online was conducted. Transcripts were analysed using thematic analysis. Results Four themes were developed: (1) Identifying psychotic-like experiences would be complicated; (2) Psychotic-like experiences can feel overwhelming for women and midwives; (3) This is my responsibility: I’ll do what I can to support women even if it’s hard; and (4) The system feels unsafe and insecure which makes the anticipated role in supporting psychotic-like experiences harder. Conclusion Midwives described their motivation to support mothers with PLEs but articulated many factors that made this difficult. The results emphasise the importance of training and guidance for midwives to support them being able to offer support and information to mothers. The findings also highlight the importance of systemic safety for midwives alongside support through supervision and reflective practice.

“It seemed like she just wanted me to suffer”: Acts of obstetric racism and birthing rights violations against Black women

IntroductionStudies that examine obstetric violence and mistreatment during perinatal care demonstrate that Black women experience higher levels of harm and abuse than other racialized groups. Yet these gender-based concepts do not fully recognize the intersectional gender-and race-based harms that Black women experience within the context of quality, safety, and human rights violations in the U.S. healthcare system. MethodsWe performed qualitative secondary analysis from Black women participants in the Giving Voice to Mothers (GVtM) study (n = 304). Primary data collection for the GVtM survey spanned from 2016 to 2017, and our analysis occurred in 2023, focusing on the interpretation of open-ended responses to three categories of inquiry: worst experiences with perinatal care, experiences of being pressured to undergo medical interventions, and desired revisions to birthing experiences. We employed a deductive approach and applied two analytic frameworks – obstetric racism and the Black Birthing Bill of Rights (BBBR)– to categorize Black women's narratives of harm during perinatal care as quality, safety, and human rights violations. ResultsBlack women described perinatal care experiences with considerable violations of the BBBR, including disrupted time with babies, racially discordant care, and unaffordable care. These experiences illustrated all six domains of obstetric racism. ConclusionThis study contributes to an emerging body of Black feminist approaches to knowledge production in obstetric patient safety, emphasizing the critical intersection of gender and race. Furthermore, this study underscores the value of using Black-women-defined frameworks with typologies to interpret the distinct experiences of Black women instead of the more limited gender-based concepts of obstetric violence, mistreatment, and respectful maternity care that lack historical context and contemporary implications of anti-Black racism and misogynoir.

A qualitative study exploring the perinatal experiences of social stress among first- and second-generation immigrant parents in Quebec, Canada

BackgroundPerinatal psychological distress adversely impacts the well-being and social adjustment of parents and their children. Expectant parents who have migrated may be at higher risk for perinatal psychological distress due to various migration-specific stressors and healthcare service barriers. Limited studies have examined the perceived determinants of perinatal distress in immigrant parents, particularly men. This study explored first and second-generation immigrant parents’ lived experiences of social stressors and facilitators of perinatal psychological well-being.MethodsParticipants were recruited by convenience and purposive sampling as part of a larger study. Semi-structured interviews were conducted virtually with first and second-generation immigrant women and men in Quebec, Canada. An inductive thematic analysis was performed.ResultsSixteen women (age = 34.8 ± 3.7 years) and ten men (age = 35.1 ± 4.9 years) from various ethnic backgrounds participated in the study at 7.4 ± 0.73 and 7.5 ± 0.72 months postpartum, respectively. Three themes were identified: (1) cultural pressures (cultural differences in parenting, gender-related cultural pressures, health and baby-related practices), (2) health and social service access (social benefits and resources, and systemic barriers in health care), and (3) discrimination (physical appearance or parental-related discrimination, gender-related discrimination, ethnic-related discrimination). First-generation immigrant parents reported greater acculturative stress (i.e. mental health stigma, health care access) and ethnic discrimination concerns related to their distress. Among men, barriers include feeling as though the paternal role was devalued by society and not receiving consideration by health care.ConclusionsOur results highlight different social factors of perinatal well-being perceived by men and women from various ethnic and immigration backgrounds during the perinatal period. Perceived factors include macro-level factors, such as a country’s social climate, health and social policies and services, and social aspects of acculturative stress. Our findings suggest the need for continued efforts to challenge and eliminate discriminatory practices. Interventions and resources directed at first-generation immigrant parents should be bolstered. Understanding what parents perceive to facilitate or hinder their psychological well-being can help inform the development of tailored evidence-based programs and policies to better meet the mental health needs of Canadians and reduce gender disparities in the treatment of perinatal distress.

Latina Women’s Perinatal Experiences and Perspectives Around Discrimination, Anti-immigrant Policies, and Community Violence

ObjectiveTo describe experiences of Latina women who were currently pregnant or recently gave birth around discrimination, anti-immigrant policies, and community violence during the early COVID-19 pandemic. DesignQualitative secondary analysis. SettingOnline or phone interviews. ParticipantsLatina women who were currently pregnant or recently gave birth (N = 26). MethodsWe used reflexive thematic analysis to examine transcribed data from semistructured interviews conducted during the early COVID-19 pandemic with a subgroup of participants enrolled in a larger study related to prenatal care. Participants were English- or Spanish-speaking, Medicaid-eligible, Latina-identifying women who resided in Fresno County, California. We analyzed responses to questions about personal discrimination, the Black Lives Matter movement, and immigration policies using the theoretical frameworks of critical race theory and the political economy of health. ResultsWe identified four major themes: Avoidance of Community Engagement, Chronic Fear and Vigilance, The Role of Media, and Everyday Discrimination and Injustice. ConclusionParticipant experiences reflect the pervasiveness of fear and socioeconomic inequity and call attention to the racialized structures that affect health and health care access for Latina women. These exposures during the perinatal period may have intergenerational effects. These findings underscore the need for responsive and race-conscious perinatal nursing care for Latina women, assessment of the effect of the current sociopolitical environment on well-being, and policies that support equitable access to health and social care.

Lived Experiences of Migrant Fathers in the Perinatal Period: A Systematic Review and Analysis.

The worldwide population of migrant families is on the rise, and there is growing acknowledgement of the significance of supporting parental mental health within these families. However, understanding of the experiences of migrant fathers during the perinatal period remains incomplete. The objective of this review is to provide an overview of existing research on perinatal migrant fathers' experiences in different cultures. Multiple searches were conducted in April 2023 for quantitative, qualitative, and mixed-methods studies across six electronic databases: Medline, CINAHL, Embase, PsycINFO, Web of Science, and Scopus. Fourteen eligible articles were identified, including nine qualitative studies, five quantitative studies, and no mixed-methods studies. The Mixed-methods Appraisal Tool was used to assess the quality of these studies. The quantitative findings were transformed into narrative summaries to be analysed thematically along with the qualitative data. Three themes were identified: (1) Cultural competence (dealing with cultural differences, needs related to original country); (2) Parenthood in a new country (challenges and adaptation to fatherhood, challenging traditional gender norms, lack of extended family and building new support networks, being the main supporter for the family); (3) Needs of the fathers and their personal difficulties. The findings of this review suggest a direction for future research in perinatal psychology. The review also provides insights into the need for social and community support for migrant fathers and how healthcare services can support this group during the perinatal period.

Toward a semiotics of midwifery: Multimodal communication's effects on accessibility, equity, and power dynamics.

According to semiotics, we live in a world of signs, where almost anything can act as a signifier and convey meaning. But what of the semiotic landscape of midwifery? What signs are present within a client's multi-sensory experience of their midwifery care? How are these signs functioning to increase equity and accessibility? Or worse, how might certain aspects of the client's experience communicate unjust power dynamics? Semiotics allows us to examine a wide communicative and educational environment. By paying particular attention to the multivalent meanings of different signs-be they written, visual, oral, or even physical-we can start to see how multimodal communication plays a vital role in a client's perception of equity and power. One way to improve client experience is by approaching education and semiotic experience from the same place as trauma-informed care. A more health-literate sensitive approach viewed through the lens of semiotics assumes all clients have little previous knowledge or comfort within a care setting. This hyperawareness and criticality of the semiotic environment would allow midwives to acknowledge various sensory and communicative biases and intentionally redesign the entire client experience. The semiotic landscape is then curated to meet the needs of the most important audience-those marginalized and discriminated against whether that is because of education, finances, race, gender, or any other intersectional identity. We must acknowledge the fact that all sign systems can either reinforce abusive power relations or work to improve them. For what is at stake here is not just a client's overall comfort, but their full understanding of the care they are receiving, the options they have, and their autonomy within their entire perinatal experience.

Maternal birthplace and experiences of perinatal healthcare in Belgium: Evidence from a cross-sectional survey

BackgroundPatient experience is an important part of perinatal care quality. Migrant women in high-income countries often report more negative experiences than non-migrants, but evidence in Europe is patchy. In this study, we compared the experiences of two migrant populations with non-migrants, taking into account socioeconomic characteristics. MethodsWe surveyed mothers born in Belgium, North-Africa, and Sub-Saharan Africa (n = 877) using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. Two patient experience scores were created using multiple correspondence analyses: a) information and communication with healthcare professionals and overall satisfaction with pregnancy care, and b) patient-centred aspects and satisfaction with delivery care. Through descriptive analyses and multivariable logistic regressions we estimated the associations of maternal characteristics with each score. ResultsOverall, positive experiences were reported in terms of communication (83 %) and patient-centred care (86 %). North African immigrants with low language proficiency had higher odds of negative communication experience (especially problems understanding information) (ORa: 2.30, 95 %CI 1.17–4.50), regardless of socioeconomic position. Among women with language barriers, 88 % were never offered a professional interpreter, relying on family members for translation. Patient-centred care was not associated with maternal birth region but was rated more negatively by older mothers, those with longer residence in Belgium, and higher majority-language proficiency. ConclusionIn Belgium, perinatal care experiences were generally positive, although communication with immigrants was suboptimal. Language barriers, single motherhood, and unstable housing increased communication issues. Our findings underline the necessity to improve information-exchange with immigrants and socioeconomically vulnerable women.

What Do Community Doulas Think About the Future of the Doula Workforce?

Expanding access to doula care is a key strategy for improving the perinatal experiences and health outcomes of birthing people of color in the U.S. This study investigates the future of maternal healthcare in the U.S. from the perspective of doulas and highlights emerging technology and other opportunities related to strengthening the doula workforce. The study recruited community doulas from 12 unique U.S. states, ensuring at least half of the doulas predominantly served communities of color. Doulas (N = 26) participated in semi-structured, futures-oriented interviews that explored their experiences providing care during the COVID-19 pandemic and utilization of technology. A subset of doulas (n = 8) were engaged in interactive workshops where they envisioned alternative futures for doula care and childbirth. Interviews and workshops were analyzed using the Framework Method. The COVID-19 pandemic heightened technology use among doulas and increased client accessibility. Social media serves as a unique space for critical community building and client outreach. Doulas reported opportunities to strengthen and mobilize the future workforce: recognizing doula care as a reimbursable service by health insurers, utilizing doula collectives for community practice to decrease burnout, increasing emotional support for doulas, and instilling a chain of learning through mentorship. Futures thinking served as a valuable approach for doulas to illuminate the implications of present-day challenges and empowered doulas to design roadmaps toward better futures for doulas and maternal health. Doulas should be engaged as partners to hold a meaningful decision-making role when discussing policies, employment structures, emerging technology, and other aspects of doulas' positioning within the healthcare system.

Existential Questions in Perinatal Psychology: Art Therapy Methods in Working with Perinatal Loss

Today, great attention is paid to the topic of perinatal losses, including “recurrent miscarriage” and infertility of unknown origin. Not only the psychological, but also the medical community is sounding the alarm on this issue, since the demographic crisis is also a state threat to our time. The author proposes to consider the main causes and psychological aspects of perinatal loss. The article outlines technologies for supporting in art therapy, to help lients during both the acute stage of experiencing loss and in preparation for subsequent pregnancy. Practical exercises for working with clients using art therapy tools are proposed and signs of successful solving problems of experiencing loss in the perinatal sphere are identified. To solve existential issues in perinatal psychology, art therapy methods show their reliability and effectiveness when accompanying the client at all stages of experiencing loss.

Unmet Expectations, Unmet Needs, and Uncertainty–A Qualitative Survey Study of Women Who Described Giving Birth as Traumatic

Abstract: Traumatic childbirth can have wide-ranging consequences for birthing individuals. Data were obtained from a large-scale ( N = 1,210) online survey of perinatal experiences in the United States. Utilizing a Reproductive Justice framework, we analyzed open-ended responses regarding the most difficult aspects of pregnancy and childbirth from 54 participants who solely identified their births as traumatic. We identified the following themes: Mental and Emotional Toll; The Toll of Relentless Work Expectations; The Embodied Toll; Complications and Interventions; Loss of Control: Bodily Autonomy; and Loss of Control: Interactions with Medical Systems and Professionals. Results underscore the inadequacy of perinatal support in the United States, highlighting the imperative to address policy and research to advance the UN Sustainable Development Goals of Good Health and Wellbeing and Gender Equality.

Understanding of perinatal mental health and its psychosocial determinants through Ukrainian women's experience.

Perinatal mental health defines new mothers, their families, and the social, emotional, and cognitive development of their children. The factors contributing to Ukrainian mothers' mental health are not well-defined in the literature. This study aims to explore how Ukrainian women understand mental health and its psychosocial determinants through their perinatal experience. This qualitative analysis is part of a larger mixed-methods study exploring perinatal mental health in Ukraine. Five online focus groups (n=30) with Ukrainian mothers of children aged 0-5 years were conducted in June-July 2020. The participants were selected from a pool of 1634 women who completed an online questionnaire and agreed to participate in further research. Informed consent was obtained. The data collected from the focus groups were transcribed verbatim and analyzed thematically using Dedoose software. The study identified two themes. The first theme was: 'Understanding perinatal mental health through women's experience', which covers five subthemes. The second theme was 'Psychosocial determinants of maternal mental health', which includes six subthemes. Overall, women's feelings of guilt, blame, and shame during their perinatal journey are influenced by socio-cultural factors and can lead to mental health problems and reluctance to seek proper help. The study has identified some factors that can contribute to the enhancement of mental health and well-being of mothers in Ukraine during their perinatal journey. Negative emotions such as guilt, blame, and shame can have a significant impact on their ability to seek the necessary support, and should be addressed by midwives and other healthcare professionals.

Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts

IntroductionRacial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. MethodsPeer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. ResultsThe study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. ConclusionPregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.