New Hampshire has recently experienced rising inequities in maternal morbidity and mortality, with mental health and substance use contributing to over half of pregnancy-related deaths from 2019–2023. This qualitative project explores the early development of the New Hampshire Perinatal Quality Collaborative (NHPQC), a statewide, community-driven initiative to improve maternal outcomes. Using maximum-variation sampling, interviews were conducted across four regional coalitions—Nashua, Manchester, Claremont, and Rochester/Dover—to understand emerging priorities, organizational structure, and implementation challenges. Preliminary thematic analysis identified recurring needs for improved communication pathways, streamlined coordination, integration of social services, and addressing maternity care deserts following multiple hospital obstetric unit closures. Participants emphasized the importance of community partnerships and equitable resource distribution to reduce preventable postpartum deaths, 79% of which were deemed preventable. Ongoing analysis will inform NHPQC strategic planning, stakeholder engagement, and statewide quality-improvement recommendations.