--- - |2 ABSTRACT Medically high‐risk pregnancy (MHRP) affects 3 to 10% (diagnosis‐dependent) of pregnant women in the United States (National Institute of Child Health Development, 2015), threatening maternal and fetal well‐being. Although mothers’ prenatal distress and mother–infant attachment after birth have been quantitatively researched, little research has examined women's lived experiences of MHRP in the United States. We examined 16 women's experiences of MHRP during hospitalization at an urban, Northeastern U.S. hospital using an interpretive phenomenological approach. Our qualitative findings provide new understanding of how women expend tremendous energy simultaneously navigating new roles of mother and patient. While negotiating these roles, they experienced dialectical struggles and uncertainty relating to emotion management, locus of control, appraisals of self/others, and relational self. Women managed these conflicts within the contexts of their emerging maternal identity, patient–provider relationships, and social relationships. Women struggled as they managed emotion, determined their level of responsibility for fetal outcomes, appraised others and themselves, and worried about how they were perceived. This amplified distress and contributed to women's emotional exhaustion, sense of being overwhelmed, and stress burden. New explication of these energy‐depleting dynamic processes underlying women's experiences of MHRP and their impact on the future mother–infant relationship is considered, and strategies for psychosocial support are identified. - Infant Mental Health Journal, EarlyView.