<![CDATA[Introduction: very high risk pregnancies remain a significant maternal health issue, contributing to an increased likelihood of complications during pregnancy and childbirth. One major contributing factor is the refusal to use contraception, which is strongly influenced by social circumstances, particularly among mothers with very high parity. Method: this report adopts a case study approach within the framework of comprehensive midwifery care. The subject is Mrs. “H,” a 33 year old woman, G10P70027, at 32 weeks of gestation. Data collection was conducted through subjective and objective assessments, physical and supporting examinations, and risk evaluation using the Poedji Rochjati Score Card (KSPR). Results: the assessment indicated that the mother was categorized as having a very high risk pregnancy, with a KSPR score of 14. The elevated risk was attributed to high parity, short interpregnancy intervals, and a history of abortion. Contraceptive refusal was influenced by prior experiences of side effects and negative perceptions within the social environment. Following continuous education and contraceptive counseling involving her husband, the mother demonstrated improved understanding of the risks associated with repeated pregnancies and the benefits of postpartum contraception. Conclusion: very high risk pregnancies among mothers with high parity are closely associated with contraceptive refusal shaped by social factors. Comprehensive and continuous midwifery care that actively involves family members has proven effective in enhancing maternal understanding and readiness for postpartum contraceptive planning. Keywords: Very High Risk, Contraceptive Refusal, Contraception]]>
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