Federal legislation was enacted in the 1980’s to expand Medicaid eligibility of prenatal care coverage. Despite this focus however, many women still continue to not utilize care early or adequately (Regenstein, Cummings, & Huang, 2005, p.1). This study examines how barriers to utilizing early and adequate prenatal care, such as a lack of transportation and/or childcare, affect women of low income living in Rhode Island. Specifically, the focus is on the clients’ perceptions of the client-prenatal service provider relationship. This study also examines the impact of utilization of early and adequate prenatal services, and of substance use, on birth outcomes for participants. It is hypothesized that those women who report having negative relationships with their services providers utilized prenatal care less sufficiently than their counterparts who report having positive relationships with their service providers. The participants who completed the survey instrument were comprised of 14 low income women living in Northern Rhode Island. Ten participants reported initiating care in the first trimester, while four began utilizing care in the second trimester. All participants initiated care reportedly in the trimester they learned they were pregnant. The mean number of prenatal visits attended was 9.67, excluding two participants who had not given birth yet. The results highlight the experienced barriers of transportation, childcare, and client-service provider relationship, as well as the presence of substance use, for participants who utilized adequate and adequate plus, intermediate, and inadequate or severely inadequate prenatal care. In addition, the study looked at the level of utilized care, barriers experienced, and substance use in relation to birth outcomes. Limitations of the study and implications for social work practice, policy, and research are discussed.