Introduction: Preconception care aims to improve the health outcomes of parents and their children by optimising health prior to pregnancy. However, inconsistent adoption of preconception care guidelines and low uptake among women highlights the need for further exploration. Aim: This study aims to explore women's perceptions of the need for preconception care and the factors influencing these perceptions, including competing demands and expectations perceived by women while planning for pregnancy. Methods: A participatory, qualitative approach was used, involving in-depth semi-structured interviews with reproductive-aged women in Australia. Reflexive thematic analysis was conducted on interview transcripts, including Synthesised Member Checking to verify findings. Results: Interviews were conducted with 38 women. Three major themes emerged: (1) “Advice from trusted people will go a long way” emphasized the value of trusted connections and expertise; (2) “A bit of a baby factory” highlighted women's sense of sole responsibility for pregnancy outcomes requiring their extensive efforts to avoid subsequent feelings of guilt and blame; (3) “If people knew” described women's preference for privacy to avoid scrutiny and judgment. Discussion: Women's perception of the need for preconception care is shaped by intersecting issues of trust, individualised responsibility, and privacy. In the absence of relationship-based care with a trusted primary care provider, women seek lived experience and formal expertise online. Individual responsibility for preconception health is disempowering to women. Relationship-based models of primary maternity care, including midwifery models of care, and parasocial connections with experts may better meet women's health needs in the preconception period.