During pregnancy, low-income women are at high risk for depression and posttraumatic stress disorder (PTSD), but they are unlikely to receive mental health services. As a follow-up to Narayan et al. (2017), we provide a detailed picture of pregnant women's mental health service (MHS) need versus utilization. Results suggested that the majority of women with very elevated depression and PTSD symptoms received MHSs during pregnancy. However, few women with lower-grade depression received MHSs, despite meeting prenatal depression criteria recommended by the American Academy of Pediatrics. Pregnant women of color were also especially unlikely to receive MHSs. Inefficient transportation and lack of child care were primary issues interfering with service utilization. Detailed recommendations for how to improve MHS access are discussed.