PURPOSE Dental services during pregnancy can improve maternal oral health, reduce mother-child transmission of cariogenic bacteria, and create opportunities for anticipatory guidance. The purpose of this study was to understand why low-income women did or did not utilize dental services in a pilot program to promote dental visits during pregnancy in Klamath County, Ore. METHODS Women were selected randomly from the pilot program. 51 women were asked to participate in semistructured telephone interviews regarding utilization of dental services during pregnancy. 45 women (88%) utilized dental services and 6 did not. Transcripts were content analyzed using a mixed method qualitative approach--grounded theory and stages of change model--to identify themes. RESULTS Most women overcame stress or dentally related barriers to obtain care. Stressors included poor domestic relationships, personal finances, and employment. Dentally related factors included perception of dental experience, attitude toward dental providers, importance/valuing of oral health, perceived ability to pay for care, time constraints, and dental providers' and office staff attitudes toward clients. CONCLUSIONS Pregnancy stressors and dentally related issues were identified as barriers to utilizing dental services. Identifying barriers that prevent women from taking action to access dental care may provide essential information for enhancing programs to promote dental visits during pregnancy.