Nurses must avoid punitive and judgmental attitudes when working with substance abusing pregnant women. It is important for nurses to recognize that these women are often lonely, scared, and vulnerable and without positive support networks (Levine, 2001). Punitive attitudes will quickly alert a pregnant substance abuser that the nurse is unable to appreciate her difficulties or meet her specialized needs (Jansson & Velez, 1999). In an attempt to avoid condemning the mother, a nurse can take some of the emphasis of the mother by focussing on the potential for positive outcomes and the well being of her baby (Jansson & Velez). Rude, judgmental and punitive attitudes on behalf of health care professionals are unethical and unacceptable. Nurses should play a role in validating that these demeaning practices are oppressive to women with substance abuse problems and should not be tolerated (Carter, 2002). In attempt to de-stigmatize substance addiction nurses and all health care professionals must take the view that addiction is not a crime deserving punishment but instead, addiction is an illness that is deserving of treatment (Jansson & Velez, 1999). According to Jansson & Velez (1999), the first step in breaking down barriers to prenatal care for substance abusing women is to establish a rapport with the woman. A philosophy of mutual respect and understanding will facilitate the development of a trusting relationship between the nurse and her client (Jansson & Velez). A non-threatening, non authoritative approach should be used (Mitchell et al. (2003). Nurses must be able to communicate patience and understanding to their clients (Jansson & Velez). Nurse should also be mindful of the importance of empathizing with their clients instead of sympathizing as a strategy of building trust (Jansson & Velez). Providing a small amount of information at one time, so as not to overwhelm and encouraging small accomplishments will help to facilitate a working relationship (Jansson & Velez). The literature suggest that in establishing a rapport with substance abusing pregnant women it is essential to be responsive to the clients needs as defined by her, and not expert�s concepts of the nature of the needs (Poole, 2000). The role of the nurse when working with substance abusing pregnant women is to empower them. Carter (2002, p170) describes personal empowerment as �increasing client�s personal, social and political power so that they can change their situations and prevent reoccurrence of problems.� The nurse can offer several strategies to empower her client and bypass some of the identified barriers. Nurse can work collaboratively with their client on how to make formal complaints for unprofessional care in perinatal facilities; this action will enable the client to advocate on their own behalf (Carter). Other strategies for empowerment identified by Carter include: role playing for the purpose of skill training and increasing self esteem, should negative or disempowering situations arise.