"They were my anchors" Māori with perinatal mental illness identify culturally safe and clinically excellent health care.

Background: Clinicians can mitigate the impact of invalidating or traumatic clinical experiences by actively working to ensure that the clinical interface is a space that is safe, inclusive, and responsive. In Aotearoa, New Zealand (NZ) the cumulative and ongoing effects of colonisation drive significant health inequities experienced by the Indigenous Māori population. Systemic health inequities extend across the perinatal period for Māori mothers and birthing parents with mental health outcomes being particularly poor. Previous invalidating or traumatic experiences at the clinical interface may impact a person's ability to trust or feel safe with clinicians.

Aim: The aim of this paper is to explore Māori mothers' and birthing parents' experiences of clinical interactions during the perinatal period to guide clinicians in providing high-quality, culturally safe perinatal mental health care.

Methods: This qualitative study was guided and informed by Kaupapa Māori methodology. Semi-structured interviews were undertaken with 19 Māori mothers and birthing parents.

Findings: Participants described the challenges they experienced at the clinical interface and also offered insights around positive interactions they encountered with clinicians. Three themes predominated the analysis of Māori mothers and birthing parents: whakawhanaungatanga (relationships, building connections); kaitiakitanga (guardianship and protection); and mana (prestige, dignity).

Discussion: Themes from the clinical experiences of Māori mothers and birthing parents when seeking perinatal healthcare outline important dimensions of positive clinical encounters. During the perinatal period these dimensions were promoted through continuity of care and the inclusion and centring of whānau (family, wider support network).

Conclusion: Quality clinical care occurs within a system, and structural components of the health system can influence practice and impact provision of care. It is systemic changes that will facilitate clinicians' contribution to equitable outcomes for Māori, through the creation of services that support clinicians to prioritise working with whānau, engage in culturally safe practice, and address the barriers that prevent Māori from accessing evidence-based healthcare. Whakawhanaungatanga, kaitiakitanga and mana are essential to enhancing clinician-patient/whānau interactions in perinatal mental health care. To facilitate these relational values and practices, healthcare organisations must adapt health system structures to support whānau-centred practices. Recommendations from participants within this study provide important directions to guide clinical practice.