Pregnant women who use illicit substances may avoid routine perinatal care as a result of the stigmatic attitudes of care providers (Irwin, 1995; Kearney, 1995; Levine, 2001). This is detrimental as the time period around the birth of a child may be a time when women who use illicit substances may be motivated to change (Tait, 2000). Client-nurse relationships have been shown to be health promoting (Hartrick & Varcoe, 2007), therefore it is important for vulnerable women to engage in relationships with perinatal nurses. There is little empirical work looking at the relationships between clients who use substances and perinatal nurses. The purpose of this critical feminist study was to examine the relationships between perinatal nurses and clients who used illicit substances or methadone. Focus group interviews were used to collect data from perinatal nurses about caring for clients who used substances while clients who used substances were individually interviewed about their experiences with nurses. Ten nurses and three clients participated in the study. The findings revealed four layered themes. Navigating barriers in a fragmented healthcare system illuminates how limited healthcare resources and hospital policies affected relationship development between nurses and clients who used illicit substances. Reinforcing marginalization and stigma reflects how clients who used substances in pregnancy were judged by healthcare professionals, impeding relationship development on an interpersonal level. Doubting honesty reveals an absence of trust in client-nurse relationships when the client used substances. The fourth and final theme, negotiating relationships as a means to an end, displays how relationships between nurses and clients who used illicit substances were superficial, and developed for the wellbeing of the infant. These findings have implications for nursing practice, health policy, research and nursing education
