Objective <p>We aimed to explore how women living in places with legalized recreational cannabis perceive perinatal cannabis use, and how legalization potentially impacts their experiences.</p> Methods <p>Between September 2024 and December 2025, we searched databases including PubMed, CINAHL, Scopus, PsycINFO, and Web of Science. All research reports were screened and evaluated based on the inclusion and exclusion criteria. Theory-generating qualitative meta-synthesis methodology was used to extract, analyze, and synthesize the findings from included qualitative research reports. Quality appraisal of each study was also conducted.</p> Results <p>Nineteen qualitative research reports were included, and eight themes were identified. Themes included (1) recreational cannabis legalization, (2) clinical policies and practice, (3) stigma and discrimination, (4) access to and desire for information, (5) clinician-patient relationships, (6) most trusted sources: family and friends, (7) perceptions and experiences and (8) self-management.</p> Conclusion <p>This qualitative meta-synthesis highlights the complex interplay of public policy, institutional and community, interpersonal, and intrapersonal factors influencing women’s perceptions of and experiences with perinatal cannabis use, as well as provides valuable insight into the decision-making process. These implications can help inform targeted public health and clinical practice interventions to address the complexities of cannabis use during the perinatal period.</p>