Background The number of pregnant problematic substance users presenting to addiction services in the UK has increased.1 These women are significantly less likely to maintain regular contact with maternity services and will experience poorer maternal and neonatal outcomes.2 Recent health policy has highlighted the need for improvement.1,–,4 To achieve this, greater understanding of the experiences of substance users who have accessed antenatal care is needed.

Methods Eight one-to-one, semistructured interviews were conducted with pregnant substance users, accessing the addictions antenatal clinic at the Royal Victoria Infirmary, Newcastle-upon-Tyne. The aim was to explore the lived-experiences of the women and identify factors which prevent or facilitate their seeking of antenatal services.

Results Personal and interpersonal factors and factors relating to the structure of services, all affected a woman's willingness and ability to engage with maternity care. A key theme, ‘social mores’ highlighted the effect of stereotypes and stigma, often creating a power dynamic detrimental to the care of mother and baby. Perceptions that services focused only on fetal wellbeing and not maternal might also discourage engagement in women already possessing low self-esteem.

Conclusion Factors affecting access to antenatal services for pregnant substance users should not be compartmentalised but viewed within the context of how the pregnancy has impacted upon a woman's life and her previous experiences of services. Influences affecting access can pervade across the whole pregnancy experience, affecting current and subsequent pregnancies. Wider solutions to the problem of engagement should be sought, including challenging ideas of what constitutes ‘normal’ and ‘deviant’.