OBJECTIVE : To explore the attitudes and opinions of student midwives toward drug use before educational intervention. To measure the attitudes of student midwives toward substance using pregnant women before and after educational intervention. To explore the role of the education on attitude change toward pregnant drug users following educational intervention. METHODS : The research used case study methodology. It was conducted in 3 phases; Likert style questionnaires (Jefferson Scale of Physician Empathy and Medical Condition Regard Scale), Virtual Learning Environment discussion board analysis and semi-structured interviews. METHODS : The 'case' was a single delivery of a university distance-learning module 'Substance Misusing Parents.' METHODS : The participants were 48 final year student midwives across eight NHS Trusts in the UK. RESULTS : The general empathy levels showed no significant change (p = 0.539), but empathy toward pregnant drug users statistically improved following the education (p = 0.012). Furthermore, students' experiences of the education demonstrated the importance of sharing and reflecting on practice with peers; the mode of delivery; the experiences of drug users, both positive and negative; and making sense of these experiences, thus bridging the 'theory-practice divide,' as key in influencing this change. CONCLUSIONS : The study has provided new insights into, the position of student midwives in the UK in terms of their attitudes toward pregnant drug users. It has also provided insight into the required nature of education aimed at altering attitude toward drug use; demonstrating the importance of critical reflection, offering e-learning as an effective model for education design. It has furthermore, confirmed the work of others regarding stigmatisation of drug users in practice and the importance of service user input to education. CONCLUSIONS : This research demonstrates the positive potential of education in changing attitude and offers suggestions for effective methods of educational delivery to help reduce stigma in midwifery and other areas of practice.