Various theories exist for the ways in which social and material disparities are incorporated within human bodies and then expressed as health outcomes with uneven distributions. From a political economy perspective, one pathway involves processes of social exclusion that take place on articulating local and global fields of power. This study explores such situated processes as they produce and perpetuate embodied inequality at childbirth in the Kilombero Valley of South–Central Tanzania. Ethnographic narratives illustrate how these processes differentially affect the kind of care women seek and receive. Also described are women’s complex yet pragmatic responses to potential exclusion in the attempt to secure a safe and otherwise positive outcome. In a culturally constructed world of childbirth, face-to-face claims on entitlement to biomedical services collide with enactments of discrimination at multiple levels, creating a space of contestation for social and material positioning as well as for physical well-being.