Obstacles within the United States current health care delivery system limit the receipt of adequate prenatal care even when access to the care exists. The author believes that contradictions in the delivery of health care are magnified in the United States since not all of the population has health insurance. Fifty-three clinic patients at a large inner city teaching hospital were observed through pregnancy and birth to the post-partum period over an 18-month period in 1981 and 1982. Twenty-seven of the women identified themselves as Puerto Rican and the remaining women were white, native-born American citizens of at least second generation. Nevertheless, the two groups of women shared similar demographic characteristics except for the ethnic differences. The author conducted her own interviews with the women, as well as with residents and other staff members. Furthermore, the author states that "because I found women shared similar attitudes and experiences during pregnancies and prenatal care, I began to focus on issues of social class". The author reports collective impressions of the women, as well as individual women's feelings.

Staffing positions at the clinic were hierarchically organized. Although the division of labor was compartmentalized, no one division felt accountable for the functioning of the clinic since the lines of authority was dispersed widely. The priority of the administrators was revenue production; thus, they emphasized the importance of seeing as many patients as feasible in the shortest time. As a result, the women experienced discontinuity of care and reported that they felt that no one cared. The women were not concerned with their limited control of pregnancy care and decision, "as are many middle class women," but they simply wanted a physician who was knowledgeable about their case, who cared, and treated them with respect. Class, race, and gender differences between the women and the physician created further barriers to the asymmetric doctor-patient relationship. All residents were self-identified as middle or upper middle class, most were white, and seventy-five percent were male. Furthermore, the residents had prior limited contact with "poor or low-income women dependent on government services or with distinctive ethnic or racial groups of the clinic population." The women felt that the residents did not provide information about their pregnancy and that the residents used unfamiliar medical terminology when they spoke to them. However, residents commented that they expected the women to ask questions about their pregnancy if they were interested. The lack of information about the progress of their pregnancy created anxiety in the women. The experiences at the clinic produced anger, frustration, or resignation in the women. The negative behavioral response of the women reinforced the physicians' preconceived perceptions of the women. Residents described their clinic responsibilities as burdensome and believed that the discontinuity of care adversely affected both their ability to achieve rapport and provide care to the clinic patients. Residents focused on technical aspects of care to the exclusion of communicative skills. In contrast, all twenty-one women who saw midwives at the clinic were satisfied with their care. The midwives viewed themselves as primary care providers, while ob-gyn residents saw themselves as specialists.

The author states that the allocation of labor in the clinic, the doctor-patent relationship, and the resident training – barriers and contradictions rooted in the health care delivery system – limit the effectiveness and efficiency of care provided in public clinic arena. Administrators and health care providers view these problems as simply minor inconvenience in patient services. The negative experiences and attitudes of the women about the care and services they receive at the clinic may prevent them from returning and adversely impact future birth outcomes. The author feels that the conditions at the public prenatal clinic reflect the structure of the capitalist American society, which emphasizes profit and power over equality. Nevertheless, slowly but ultimately, poor women have benefited from improvements in care at the labor and delivery stages initiated with private obstetric patients. While less inequality exists at the perinatal level, prenatal clinical care remains inadequate. The inequality of prenatal care persists since private and public patients are treated separately. The author states that, although “it is difficult to quantify quality care and its effect on pregnancy outcome,” results indicate that care affects “wellbeing.”

The author describes her research as a well-designed investigation into the care at a large prenatal clinic in which half of her subjects were Hispanic and the other half were White. Although she originally came to the clinic to investigate issues of ethnicity in reproductive health care, she turned her attention to the affects of poverty on prenatal care since she found that women shared similar attitudes about pregnancy and birth and similar experiences at the clinic. Nevertheless, her findings would have been more robust if the article had contained a formal assessment of the similarities and differences between both the demographic characteristics and attitudes of the black and white women in relationship to their receipt of prenatal care. Furthermore, a more direct evaluation of whether the residents believed that the race of the patient affected their treatment would be enlightening. Thus, although the anecdotal approach of the article is quite informative, substantiation of the findings are missing due to the lack of some formal analytical presentation.