Although clinicians are aware of substance abuse and violence issues that affect pregnant women, few have the opportunity to provide in patient care over a six month period during pregnancy to women with borderline personality. Usually women who have substance abuse problems and anti-social behavior during pregnancy are managed on an outpatient basis with antidepressants and counseling. In this particular case, the woman was homeless and demonstrated behaviors harmful to herself and her fetus.  Ms. T was a 23 year old immigrant woman who had been living with “family” before she became violent. She was then removed from the home and placed on her own without employment and unable to speak English. She was then incarcerated for lewd public behavior and after psychiatric evaluation, sent to the state hospital for further care. Ms. T was first seen by obstetric residents at 22 weeks gestation. She had a history of drug use, alcohol use and indiscriminant sexual behavior. At the 1^st visit, she was treated for multiple sexually transmitted infections and since she was homeless, admitted to the hospital for the course of the antibiotics. During her admission, both nursing and medical staff were astounded by her lack of boundaries. She undressed in the visitors lounge, made sexual advances to any male entering her room and used vulgar language to the nurses. Additionally, Ms. T. began trying to work the different shifts against one another and the psychiatric consultants against the obstetric caregivers. She was transferred between the ante-partum unit, labor & delivery and general psychiatry at least 5 times and twice discharged to the streets. She totally disrupted the ante-partum unit and the psych unit screeching at all hours. She cried that her fetus had died. Public actions of masturbation and defecation disgusted her caregivers and the other patients and family members.  The nurses finally identified communication and practice/philosophical issues that created dissention among the OB nursing staff, OB residents, MFM specialist, psychiatrists and psych nursing staff. After a month of meetings, a pregnancy/labor &delivery plan was developed. Delivery at 39 weeks proceeded with the plan for a tubal ligation after delivery. Ethical disagreements relating to her ability to consent to sterility, prevented her surgery from occurring. The family adopted the baby, but disowned the woman. She was returned to her home county to a shelter but reappeared in 6 months at the state hospital newly pregnant and using substances again.