Pregnant women at high risk for adverse health outcomes can benefit from the services of community health workers. Maternity Care Coalition identifies at risk women and provides links to health care and social services through the MOMobile Program. The purpose of this study was to explore (a) the relationship formed between community health workers and pregnant women, and (b) the change over time in a mother's perceived level of empowerment as measured by self-sufficiency, self-determination, and decision-making skills. A multiphase study was developed to collect data. Focus group interviews with community health workers explored their professional role, their relationship with mothers, and the meaning of decision-making, self-sufficiency, and self-determination as empowerment constructs. A questionnaire was developed to measure each construct at two points in time. A pilot study with 80 women was conducted. Scores for each construct and overall empowerment were calculated and the pre- and post-scores compared to measure change over time. Results of paired t-tests showed significant differences between the postpartum mean score for decision-making (P less than 0.01), self-sufficiency (P less than 0.01), self-determination (P less than 0.001), and overall empowerment (P less than 0.001) and the mean scores on each construct at registration. Results suggest that empowerment can be operationalized in community settings and that increasing an at risk pregnant woman's sense of empowerment may positively impact the overall health of the mother and child. Further research is needed to assess the full impact of this variable as a health status indicator. (Contains 5 tables and 2 figures.)