Judgmental and disparaging attitudes of health care professionals are a significant barrier for substance abusing women in need of prenatal care. According to a study conducted by Selleck & Redding (1997), registered nurses often hold views toward pregnant substance abusers that are more punitive than supportive. Punitive attitudes quickly alert a pregnant substance abuser that the nurse is unable to appreciate her difficulties or meet her specialized needs (Jansson & Velez, 1999). Often, attitudes of health care professionals favour the health and well being of the fetus only, while disregarding the health and well being of the women (Carter, 2002). Milligan et al. (2002) explains that condescending and judgmental attitudes expressed by health care providers lead many pregnant substance abusers to feel as though they were treated like a drug addict rather than a person worthy of respect and dignity. Both verbal and nonverbal communication quickly convey the disrespectful thoughts of health care workers to their vulnerable patients, deterring women from seeking future care (Selleck & Redding). Women experiencing drug use and addiction problems need understanding and empowerment from health care professionals in order to change their habits and develop parenting skills (Levine, 2001). However, during pregnancy substance abusing women are often subjected to stigmatization and ignorant views. In describing the attitudes of nurses, Selleck & Redding (1997) explain that society�s biased misconceptions and stereotypes influence nurse�s beliefs and attitudes. Carter (2002) describes substance-abusing women stigmatized as being immoral and deficient upon seeking prenatal care. Poole & Isaac (2001) state that women in their study felt as thought they were labeled as lazy and as failures. Women seeking prenatal care who were subjected to such stigmatization described feeling as thought they were misunderstood as well as isolated (Levine). The combination of feeling stereotyped and judged does not make for an inviting, health promoting or empowering environment. These destructive actions lead pregnant substance abusers to feel shame that negatively impacts self image, and lowers self esteem (Mitchell, Hall, Campbell & van Teijlingen 2003). The shame experienced by women further contributes to their vulnerability and powerlessness, and in turn, reluctance to participate in prenatal care (Lieber, 1994). According to Levine (2001), perinatal substance abusers who received harsh and judgmental treatment by health care professionals were very hesitant to subject themselves to the same ridicule.