Summary Substance abuse in pregnancy is associated with significant maternal and fetal morbidity. The complication for care is that the mother is the cause of the problem that potentially harms not only herself but also her unborn child. The abuse is further complicated by the associated legal, social and environmental problems. The aim for the obstetrician is to provide a non-judgemental, supportive environment to minimise the risk, not only during pregnancy and the neonatal period, but also in the long term. To achieve this, caregivers need to be multidisciplinary and tolerant of the mother's problem. The aim of antenatal care is to reduce risk, which does not mean that the mother must abstain from drug use. The aim is to keep her within the care system and encourage her to take responsibility for her situation. No-one should be turned away or denied help as, ultimately, this is harmful to the mother and her baby. To provide this care, the obstetrician needs support from midwives, addiction counsellors, social workers, neonatologists, health visitors and general practitioners. Whereas the healthcare structure in the UK lends itself to this approach, this is not the case in other parts of the world. However, programmes of comprehensive antenatal care do not universally improve the health of the mother and the outcome of her pregnancy. The specifics of the care provided are probably less important than the quality of the care given and the degree of engagement of the individual. This chapter outlines the problems and potential solutions with reference to the service in Leeds in the UK.