Role of service providers
The role of service providers is not to identify if a woman has a substance use problem. But your role is to make sure that a pregnant woman feels safe and comfortable enough to discuss her substance use with you. Here are some things you can do:

  • talk about substance use with all women
  • identify women who need help reducing or quitting substance use
  • discuss the level and type of change a woman is ready to make
  • support women by keeping the discussion open and making connections to other services as needed

Audio Transcription:

“My worker showed me that she cared about me and my child, and that, no matter what, she would help me. She seemed to like me even when I didn’t like myself.”

Fear prevents many service providers from asking questions. You might be afraid you’re not an expert in addiction treatment. So you think you don’t have the right skills. But remember: talking to women about their substance use is exactly like any other kind of conversation—you should be empathic, non-judgemental, a good listener, and able to give neutral suggestions.

Some service providers say they’re afraid to ask questions because they think the woman will be angry with them. However, remember:

  • if you ask questions about substance use in a matter-of-fact way, the woman is less likely to feel angry
  • your attitude will usually determine a woman’s reaction—if she perceives you to be fair and open, it is more likely she will be open with you

Another reason for hesitation could be this: you don’t know what to do next if she says she uses substances. Again, remember:

  • be neutral in response and try not to feel overwhelmed
  • suggest some small steps a pregnant woman can take—sometimes these small steps are all that’s needed to help her start on her recovery journey

Try this

Say “Can you see yourself making any changes to your use of substances? What would they be?”

Avoid saying “So your next step should be to quit using.”

Here are some general approaches for asking questions:

  • if you are having a conversation about sleeping patterns and eating habits, also ask about substance use, since these questions belong within the context of overall health—they will naturally flow in your conversation
  • (“how much do you drink/use drugs?”) are always better than closed ones (“do you drink/use drugs?”)
  • if the woman says she uses substances, then ask other probing questions such as “how much do you use daily or weekly?”, ”how long have you been doing this?”, and “when did you last use?”
It’s not up to you to make a diagnosis of addiction. But you can express concern for a pregnant woman’s health and the health of her unborn baby. Refer the woman to the Motherisk telephone help line at 1-877-327-4636 or their website at

Remember: many women are given inaccurate information about substance use during pregnancy, either from professionals or from friends.

Here are some ideas to help dispel myths:

1. Set the record straight.

  • talk to the woman in a conversational, matter-of-fact way
  • ask her what she’s heard about substance use during pregnancy

2. Refer to factual, easy-to-read written information (such as the Give and Take booklet or information from ).

  • review the relevant information with the woman
  • leave the information with her so she can review the facts in private and in her owntime
  • remember: it takes time to digest new information

Sometimes service providers fall into the trap of asking questions about substance use only once. Then they heave a big sigh of relief and think “thank goodness, that’s over with, I don’t have to do that again.” But remember:

  • it’s ok to ask about substance use again regardless of whether or not she initially revealed it—this shows you are willing to have the conversation
  • continue to frame the questions in a matter-of-fact way and within the overall context of her health
  • the non-judgemental approach is especially important for women who originally didn’t want to talk about substance use—these women need to know you are always open and able to listen, if they decide to reveal their substance use later on in the pregnancy.

Remember the barriers to getting help—guilt, fear of being judged, and fear of losing her baby. Also remember that service providers are in a unique position to encourage change. You can:

  • provide a lot of positive feedback for her decision to seek care for herself and her baby—continue to make positive statements every time you meet with her
  • highlight the woman’s ability to make choices—this leads to higher “self-efficacy” and helps her believe the power to change is within herself—self-efficacy is a person’s belief in their ability to make change and a high self-efficacy is the best predictor of successful change
  • be non-judgemental—this means you listen attentively to the woman’s concerns and refrain from negative comments and reactions in your body or facial language
  • encourage any small changes that reduce high risk behaviours
  • talk about substance use and pregnancy or parenting concerns—pregnant women want to be treated as whole beings, not simply as pregnant women
  • be sensitive to trauma issues—many women with substance use problems have histories of violence and sexual or physical abuse, especially those women who find it difficult to quit their substance use—substance use can be a positive coping mechanism for women dealing with experiences of trauma
  • address family issues and offer support to family members where possible.


The approach you take is one of the strongest indicators of whether a woman will change. Your ability to engage a woman in a supportive, respectful, and collaborative relationship is just as important as the woman’s personal characteristics and behaviours.