Understanding how antenatal care (ANC) is implemented in rural health centers is a current focus of the Ministry of Health in Rwanda. This qualitative study used observational and interview methods to assess the ANC workflow of 9 health centers in the Gakenke district in rural Rwanda. The purpose of the study was to identify the ANC workflow itself, identify discrepancies between the ANC in the different health centers, and identify barriers to care. A total of 49 expecting mothers and 12 ANC healthcare workers were observed in the Gakenke district within a 3-week period during scheduled ANC appointments at their respective healthcare centers. Interviews with these individuals were conducted throughout the process to assess patient and healthcare worker satisfaction with the ANC provided as well as barriers to care. The top reported barriers to care include shortage of healthcare workers, lack of adequate medical equipment, length of ANC visit, affordability of insurance, and lack of ANC educational resources.