Alabama has some of the poorest maternal and infant health outcomes in the nation and has been instrumental in politically-charged efforts to restrict access to reproductive rights and services. The 2022 Dobbs ruling led to a near-total abortion ban in Alabama and has potentially exacerbated maternal health crises and healthcare inequities, particularly for marginalized and underserved communities and for women of color. This project examines how the post-Dobbs environment is affecting overall access to, and management and experiences of, high-risk (HR) pregnancy care and assesses early evidence for health-related outcomes in Alabama. The primary hypothesis is that patients are increasingly struggling to find accurate information and appropriate access to pregnancy care, and providers are finding it more difficult to efficiently deliver evidence-based services due to uncertainties over limitations on their professional scope of practice. We will conduct a mixed-methods analysis to develop understanding of changes in the management of HR pregnancy care post-Dobbs and of early evidence on its impacts at the patient, provider, hospital, and system levels. Semi-structured interviews, focus groups, and a statewide survey of obstetricians and gynecologists will be conducted, along with a policy scan and repeated cross-sectional spatial analysis to assess service-level gaps and potential workforce shortages. Results delineating challenges to pregnancy care delivery and best practices to reduce potentially adverse maternal and reproductive health outcomes will be disseminated through journal publications, white paper and policy briefs, and presentations at statewide, regional and national public health and medical meetings of relevant stakeholders.