Abstract This study examined Amish patterns of perinatal health care utilization from the perspective of Amish women and local health care providers in Geauga County, Ohio. Participant observation and interviews with health care providers and 15 Amish women yielded data on perinatal beliefs and utilization patterns for 76 pregnancies. While local health care providers regard the Amish as suboptimally utilizing prenatal care, this study found a consistent pattern of health seeking behavior. In the absence of symptoms perceived to be serious, Amish women initiated prenatal care earlier for first pregnancies and progressively later with increasing parity. Amish women's perinatal health care utilization must be seen within the context of barriers of transportation, cost, and child care needs. The Amish do not automatically reject medical technology, but select those aspects that are congruent with and that will support and maintain their way of life. Further, despite outward appearances of homogeneity, Amish women display individual variability in responding to pregnancy and childbirth.