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Evidence has shown that medication-assisted treatment (MAT) is safe and effective for pregnant women with substance use disorder (SUD); despite this, only 9% of women receive treatment (Frazer et al. 2019). There are several motivating factors associated with pregnancy for women experiencing prenatal SUD (Lopian et al., 2019). There are also numerous available resources for pregnant women with SUD. However, there are also significant barriers that limit access and discourage women from seeking these resources. Some of these obstacles include social stigma, fear of legal consequences, incarceration, and child welfare involvement. The literature has shown that these barriers substantially affect treatment initiation and can even outweigh motivators for pregnant women with SUD (Frazer et al 2019). Based on a secondary data analysis of interviews with mothers who used opioids during their pregnancy, this paper will aim to examine how pregnancy operates not only as a motivator or barrier, but as a complex period that reshapes treatment initiation and engagement.