In 2017, approximately 8.5% of pregnant women nationwide used illicit substances during their pregnancies, up from 6.3% just one year prior (NSDUH, 2017). The trends associated with substance misuse and pregnancy are alarming given the risks to both the mother and her child (Behnke et al., 2013). Pregnant women with substance use disorders (SUDs) are thus in critical need of support during the prenatal period (American Society of Addiction Medicine, 2011). However, they also contend with stigma and the possibility of punitive responses (Terplan et al, 2015), which can result in avoidance of treatment. Prenatal care and positive patient-provider relationships are essential to improved health outcomes (Lori et al, 2011). Yet, little is known about the patient-provider relationship for pregnant women with SUDs and what facilitates trust and women’s willingness to engage in care. Informed by recognition theory and intersectionality, this qualitative study aims to fill that gap, emphasizing the ways patients and providers develop and maintain their relationships, as well as their perceptions of each other. Semi-structured interviews were conducted with N=19 postpartum women with SUDs and N=10 prenatal care providers (not matched pairs). Using a two-layered thematic analytical approach – both data- and theory-driven – this research offers a comprehensive examination of prenatal care in the context of SUDs. Women entered into prenatal care feeling ambivalent about their pregnancy, with co-existing emotions such as guilt and excitement. They were also newly motivated to protect their child, and in need of clear medical information that was free of moral judgment. Women and providers identified provider traits that facilitated trust and connection in the patient-provider relationship, such as being nonjudgmental and supportive. Women also emphasized the value of being fully acknowledged as having worth and dignity. Finally, providers discussed the challenges of working with pregnant patients with SUDs, including the limits of their compassion, as well as the limitations of the health care system. Cumulatively, these findings highlight critical needs in prenatal care for women with SUDs, such as acknowledging women’s dignity, and supporting providers with comprehensive training and a health care system better suited to meet their patients’ needs.