Respectful engagement

Treat women with dignity and respect. They are more than a pregnant woman who drinks or uses drugs. They may be a mother already, a daughter, a sister, an aunt, or a survivor of violence and abuse.

Be interested in who a woman is, what matters to her and what she holds close. Help her talk about the fears and worries she has about working with you and other services.

Explore her fears and acknowledge the obstacles

Ask how she feels about her alcohol and other drugs use and becoming a parent. Name the shame and stigma by talking with her about how she may have experienced this from family, community and professionals, and explore whether this stigma has any impact on her willingness to access support.

Even though she may be very motivated to reduce or cease her alcohol and other drugs use, still acknowledge how difficult it is to stop or get control of problematic alcohol and other drugs use.  Let her know you understand that just stopping her use is unlikely and could be dangerous for her or her baby.

Ask her what she knows about alcohol and other drugs use during pregnancy and her treatment options. If she has some information, ask her about who gave her this information and how. Talk about what worries her most about her substance use, for herself and her unborn baby.

Talk about her best hopes for being a mother

Explore what kind of mother she hopes to be. Talk about her thoughts on breastfeeding, co-sleeping and sharing parenthood with her partner.

If she has had a child taken in care previously, never ignore this experience. Acknowledge the pain she must have been through and invite her to tell you what it was like from her perspective, and the perspective of the child’s father and her family. Ask her:

• What was happening in her life then?
• What happened that led to her child need to be in care at that time?
• What steps was she trying to take at the time her child went into care and then afterwards?
• How does she reflect on this time now?
• What would she do differently? Is she doing that now? What would she do the same?
• What does she think you could do differently or the same as previous workers to be useful now?

Responding to shame and stigma

It is important to be up-front and address the shame and stigma a pregnant woman may face when she is using alcohol and other drugs. Be clear and honest about why you are there and what you can do to help. Some example questions and statements include:

• I am curious about how you feel about me coming to see you today.
• I wonder what worries you the most.
• I wonder how you feel talking with me today.
• How can I help to ease your worries?
• I am wondering if you can tell me about your worries about your alcohol or drug use now you are pregnant.
• What has worried you or others about your alcohol or drugs use before?
• What worries you about once your baby is born?
• I know this must be really hard having me here today. I just want to reassure you I have worked with lots of parents who have struggled with alcohol or drug use.
• I understand how hard it can be to get control of your use or stop it.

Understanding a woman’s fears

While the issues relevant to working with women in general are applicable to working with pregnant women, there are some unique issues you need to consider.

As already mentioned, being pregnant can be an important time for change. It is a time when a woman might be highly motivated to stop or reduce her drinking, come off drugs, or stabilise her drug use to have a healthy pregnancy and be the best mum she can be. 

But pregnancy is also a time of fear for many expectant parents—especially fear that their baby may not be born healthy or may be taken from them. This fear can cause some parents to attempt to hide their alcohol and other drugs use, particularly by avoiding services that may uncover it. This isolates a vulnerable woman further.

Women’s attempts to hide from services they fear may take their child can be interpreted negatively—for example, that they’re disengaged from services and not wanting help. This fear of services can take the form of a mother who appears to:

• not keep appointments with prenatal services
• not book into hospital until very late in the pregnancy
• not talk about her own or her partner's alcohol and other drugs use
• not want to talk with service professionals who she sees as a threat to her and her baby
• be guarded about what she tells you and only offers the minimum information she has to.

When these things happen, people can make assumptions and women can be labelled as avoidant, neglectful or lacking insight into the impacts of alcohol and other drugs use on their baby. It is important to understand what motivates a mother’s action (or perceived inaction) and work with them to overcome the deep fear they hold.

Partnering with women during pregnancy

A woman who is pregnant and fears having her baby taken away needs you to engage with her so she feels safe enough to talk with you and other professionals. This role in particular requires you to be mindful of the power and authority you hold as a Child Safety practitioner and of how families may view you.

If your approach reinforces shame and stigma, fear or worry, the pregnant woman is unlikely to open up and unlikely to be willing to be vulnerable and work with you. The idea of becoming more vulnerable than she already is can be enough to stop her from taking the first steps towards treatment and recovery.

Supporting a pregnant woman

When working with a pregnant woman through an investigation and assessment or a support service case, it is important that practitioners actively work to offer help and support to a pregnant woman to achieve her goals.  

Examples of active efforts include:

• Negotiate longer times for prenatal appointments.
• Negotiate consistent health workers for prenatal appointments.
• Offer practical assistance to get to appointments.
• Use a variety of methods to remind her of upcoming appointments.
• If appointments are missed, stay supportive and curious about why.
• Ask her how you can be of the most use.
• Link her to the hospital social worker.
• Link the woman to cultural or other supports.

Give the woman information about the potential effects problematic substance use can have on her unborn baby, and what to expect when the baby is born, for example:

• what medical care the baby may need
• where they will be cared for.

Help the mother think about and come up with questions for her nurses about the birth and care of her baby once born.