AIM: This article describes the experiences of midwives who choose to work with pregnant women who use illicit drugs. BACKGROUND: Pregnant women who use illicit drugs present complex challenges for those who choose to work with them. Society?s views on illicit drug use fluctuate from acceptance and harm minimization to reprimand and retribution. METHOD: Qualitative interviews were conducted between June and August 2009 with 12 Australian midwives. A thematic analysis method informed by hermeneutic phenomenology was applied to interpret this data to explicate lived experiences and gain deeper understanding and meanings of this phenomenon. FINDINGS: Three major themes encapsulated the experience: making a difference, making partnerships, and learning to let go. The focus of this article, ?making a difference,? included two subthemes of ?working on the margins? and ?transition and transformation.? The midwives were both rewarded and challenged by the needs of women who use illicit drugs and by the systems in which they worked. CONCLUSIONS: The midwives acknowledged that their aspirations ?to make a difference? was not always sufficient when working with women who use illicit drugs. They also require the establishment of maternity services that are compassionate and accessible, including woman?care provider partnerships and continuity of the care environments.