Date of Submission



This study sought to evaluate the care provided to chemically dependent pregnant women by a specialist clinic, the Transitions Clinic of the Mercy Hospital for Women, a major Victorian metropolitan women‘s hospital. A critical ethnographic approach informed by critical, feminist and postmodern perspectives, namely Habermas, Foucault and feminist interpretations of Foucault, was employed. During the process of data analysis I was also drawn to the existential theorists, Frankl and Yalom. Twenty women were interviewed three times (twice prior to giving birth and once post birth). As well, interactions between clinic staff and the women were observed over a twenty-five month period, field notes were taken and medical records accessed. This thesis addresses a gap in the literature in regard to chemically dependent women and their response to pregnancy, antenatal care and birth. It argues that most of the women, to varying degrees and despite significant problems, negotiated strategies for recovery and the development of a ‗mother identity‘. This was despite the fact that fifteen of the women had significant predisposing factors that had influenced development and maintenance of their chemical dependency. At the time of becoming pregnant most felt rejected by the wider society, were largely alienated from it and as a result had become immersed in the drug culture, which for some provided a sense of identity, albeit deviant. While the women‘s experiences of pregnancy were variable, a number used pregnancy and impending motherhood to construct a sense of self and discover what was possible for them. For this group pregnancy became a focus for change and transformation, but for others less so. The women‘s relationships with the clinic staff reflected their responses to care. Initially the women believed that power was exercised in all aspects of their care without consideration of what they had to offer in terms of life experiences and skills. However as their pregnancies advanced and they explored possibilities for collaboration they came to accept that they could also exercise power and a degree of control over their lives, instead of being subjected to a paternalistic approach to care. This resulted in the negotiation of a more egalitarian relationship with the clinic staff, particularly the midwives. For the majority of the women their level of motivation towards ongoing care and recovery matched the level of collaboration achieved. Pregnancy appeared to be a turning point for thirteen women with pregnancy and the birth of a child appearing to provide them with a deeper connection to life thus helping them to overcome feelings of despair and helplessness and assisting them to employ active rather than passive approaches to managing their life choices and life chances. This thesis emphasises the importance of an individualised approach to care, the need for clinic staff to work in partnership with the women and the importance of building up trust and addressing power issues. As such it has value for health care professionals caring for this vulnerable group of women.


School of Nursing, Midwifery & Paramedicine

Document Type


Access Rights

Open Access


315 pages

Degree Name

Doctor of Philosophy (PhD)


Faculty of Health Sciences