Background: Perinatal depression affects 1 in 7 childbearing individuals and remains underdiagnosed and undertreated. Individuals with a psychiatric history are at increased risk of perinatal depression, and little is known about how experiences with the mental health care pathway may differ between these individuals and those without a psychiatric history. Methods: This was a secondary analysis of data from the PRISM (PRogram in Support of Moms) study, a cluster randomized controlled trial of two interventions for perinatal depression. Care access and barriers to care were evaluated in perinatal individuals who screened positive for depression using the EPDS (N=280). Results: Individuals with no psychiatric history prior to pregnancy (N=113), compared to those with such history (N=267), were less likely to be screened for perinatal depression, and less likely to be offered a therapy referral, though equally likely to attend when referred. In adjusted models, those without a psychiatric history had 0.59 times the odds of attending therapy (95% CI 0.28-1.25), 0.23 times the odds of utilizing medication (95% CI 0.11-0.47), and overall, 0.22 times the odds of receiving any depression care (95% CI 0.11-0.43). Participants reported on average 3 barriers as preventing them from receiving care “a lot” or “quite a lot”. The proportion of individuals endorsing each barrier was similar between groups, excepting “concerns about treatments available” and “thinking the problem would get better by itself”, which were more prevalent in those without a prior psychiatric history. Conclusions: There exist meaningful differences in the way perinatal individuals access care for depression based on psychiatric history. An understanding of these differences is crucial in addressing gaps between mental health care need and care receipt.