Pregnancy as a journey of care and connection: Indigenous women's experiences navigating health systems and community support.

Introduction: Pregnancy and childbirth are opportunities for Indigenous communities to welcome new life, integrate meaningful cultural practices, and tangibly strengthen communal wellbeing. Simultaneously, pregnant American Indian and Alaska Native (AIAN) women must navigate complex healthcare systems while experiencing structural inequities that contribute to elevated risks of complications and poor birth outcomes. This study explored the pregnancy experiences of AIAN women, examining how participants navigated healthcare systems, social supports, and structural challenges. Methods: We conducted 10 semi-structured interviews with AIAN women to map care journeys and the social and structural contexts shaping them across the perinatal period. Participants were aged 18 years or older, self-identified as AIAN, and had a pregnancy within the past 2 years or were currently pregnant in their third trimester. Guided by AIAN community interest-holders, interviews incorporated a narrative pregnancy-journey mapping approach. We used a community-based participatory research (CBPR)-informed team ethnography approach that incorporated both insider and outsider perspectives. Results: The investigators identified seven themes through their analysis: cultural beliefs and traditions, prior pregnancy experiences, navigating prenatal healthcare systems, social support networks, social stressors, mental health, and birth and postpartum experiences. Many participants expressed a desire for culturally rooted guidance, including access to traditional healers, doulas, and teachings from their tribal communities. Prenatal care often required coordination across multiple healthcare systems. Family members and partners were consistently identified as central sources of emotional and practical support. While participants navigated cardiometabolic conditions and social stressors, their narratives reflected adaptability, advocacy, and survivance across pregnancy and postpartum. Discussion: Findings highlight the need for culturally grounded, relationship-based approaches to perinatal care for AIAN women. Participants described a strong desire for greater cultural connection during pregnancy. Strengths-based strategies that integrate cultural practices and expand collaboration with doulas, midwives, and community health workers may improve care experiences and support culturally responsive perinatal care.