Two recurrent unsolved problems of health services practice and policy in modern industrial countries are those of social class inequalities and user dissatisfaction. This article presents data related to these issues drawn from a sample of British childbearing women deemed "at risk" by health professionals. A third focus is on the relationship between past experiences of maternity care, and the patterns of service provision and perceptions of needs and satisfaction revealed in a subsequent pregnancy. Findings show a tendency for patterns of care to be differentiated by social class, with working class women generally receiving comparatively poor service. Satisfaction with general practitioner (community-based) prenatal care is higher than with hospital care. The more socially disadvantaged women in the sample are more likely to be dissatisfied with their medical care. The three major pregnancy needs highlighted by the sample women are for more continuity of care, more sympathetic medical care, and help with household finances. Adverse previous childbearing experiences are related to more dissatisfaction in the subsequent pregnancy.