Introduction: Women Veterans represent a growing and medically complex population within the U.S. healthcare system, yet their experiences with maternity care—especially when delivered outside the VA through Community Care Network (CCN) providers—remain under-examined. This dissertation: (1) investigates racial and ethnic disparities in obstetric outcomes, (2) evaluates a community-based doula intervention, and (3) explores how Black, Indigenous, and People of Color (BIPOC) Veterans navigate provider selection and engage with perinatal care (PC) quality measures.

Methods: Drawing on data from the Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study—a multi-site national cohort of pregnant Veterans—three analyses were conducted: (1) a retrospective cohort analysis assessing racial and ethnic differences in unplanned cesarean birth among 314 primiparous Veterans with term, singleton deliveries; (2) a mixed-methods pilot study evaluating the feasibility and acceptability of doula care among 39 referred Veterans; and (3) a focused analysis of 27 BIPOC Veterans describing their provider selection and prioritization of three PC quality measures.

Results: Non-Hispanic BIPOC Veterans had significantly higher risk of unplanned cesarean birth than White Veterans, even after adjusting for clinical risk. Doula care seemed feasible and acceptable as a potential VA maternity care benefit, with participants expressing strong interest in future use. Most Veterans selected providers based on geographic proximity or CCN inclusion. Although participants were largely unaware of obstetric quality measures or how to access and interpret such data prior to the study, when asked to rate three PC quality measures, they consistently prioritized infant safety—rating “unexpected complications in term newborns” as most important.

Conclusion: This dissertation identifies disparities and structural barriers in VA-purchased maternity care and underscores the need for improved oversight of the CCN, culturally responsive support models, and Veteran-centered tools for informed perinatal decision-making.