AIBU or was midwife stealing my morphine?

[Morphinemidwife]

Slightly longwinded background for context:
I gave birth to my DC around 6 weeks ago, ended up having a caesarian under GE so no spinal block, and a lot of complications that meant over 6 hours in surgery.
Came around in agony (spinal block apparently offers longer term pain relief), so put on a morphine pump at the request of the anesthetist from surgery and a registrar. All fine, lovely night changing and cuddling baby, some pain obviously but totally manageable and under control.

The same registrar and another Dr came later to remove the pump before ending their shift, and prescribed me 10-20ml of oramorph every 2-3 hours. Said to keep on top of the pain, as it was hard to get it gone but that it should be trivial to stop it coming back. Had first dose, few hours pass, all good still.

One midwife was responsible for me overnight, her shift starting soon after i came off the pump, she was administering my medication. She gave me 5ml of oramorph very infrequently - every 4-6 hours over the night, despite my frequent buzzing in absolute agony. By the morning I was in tears, groaning, high temperature and completely unable to move. She kept saying I should be mobile, when I couldn't move for pain. When my pain was being managed I was able to pick up my DC to change and feed etc, by this point I couldn't move to sip a drink despite being very thirsty. The midwife wrote in my notes saying I was failing to cope and look after my baby and my husband was having to take over instead. I just needed pain relief.

When the morning shift came, I asked whether I could have the full dose of oramorph as frequently as prescribed as my pain was completely unmanageable. I'd realised it had been a lost cause trying to get the correct dose overnight.
They said I couldn't, as my chart showed I'd had the maximum possible dose - 20ml every 2 hours. All signed off.

I insisted I'd had 5ml every 4-6 hours, nobody would believe me. I wasn't allowed any morphine, just paracetamol. I was in an astronomical amount of pain. This prompted a mental health referral. Overnight I had been given 15ml of oramorph, my chart said I'd had 120ml.

I had a mental health Dr come to pointedly ask me whether I had any drug problems as there was no way that dose would leave me in agony, I accused of having a mental breakdown and being "unable to cope" all day. I was accused of wanting extra morphine because I needed "an escape". I was fine, overjoyed other than the pain, just lacking any sleep and in need of pain relief. I didnt feel able to repeat my assertions that my chart was wrong to the mental health Dr, as it had prompted the referral and mutterings of SS involvement.

I ended up having to stay in hospital for 5 days, having been desperate to go home as they were concerned for my mental health because I was crying all day due to being in total pain. Being on the ward robbed me of any chance of sleep, my paracetamol wasn't even administered regularly so I only made it home when on day 5, the pain had naturally eased off a bit so I stopped crying and groaning.

Went home, giddy and happy with a new baby so thought no more of it and didn't want to focus on the negatives of the first few days.

But its just occurred to me, weeks later, how the midwife looked and was moving, her pinpoint pupils. She was taking my morphine and forging the chart wasn't she? It's bloody obvious to me looking back that it wasn't just an error like I'd initially thought.
WWYD? I could never prove it, could I?

The Dr made the comment about needing to stay topped up as when on the pump I was nervous to press it whenever I needed to for fear of being seen to "drug seek" after similar comments. So I was going hours, until the pain got unbearable, then was desperately pressing to fix it!

This is what is confusing me about the timeline. The op says she was reluctant to press the PCA for fear of being accused of drug seeking (but this was before any accusations were made so why would that be a fear?) so was going for hours before pressing it and yet by 8pm was on the ward, having had the PCA discontinued and being given the 1st dose of oramorph.

So how long was the PCA up for, bearing in mind the op went hours between pushing the button?

It sounds like the op is confused about timelines etc so may not be recalling everything accurately.

@Hearhoovesthinkzebras OP had the morphine pump overnight whilst on the postnatal ward and stated that she’s coped well looking after her baby, even though she was in some manageable pain. The morphine pump was removed before the night shift the following day, so sounds like it was in situ for 24 hours.

Would that be normal procedure ?
Making changes just before a night shift doesn't sound like a great plan....

It’s possible they thought if she wasn’t using it, she didn’t need it and could manage with oral morphine instead.

Look OP the only way to get to the bottom of this is seeing the notes.

The post by oldstripeyNEWname1 is the post OP should read and the advice OP should follow.

It is not rife in hcp ffs. All teachers are drug addicts who abuse our children. If I said that mumsnet would go mad but go for a nurse and it’s oh yes complain to pals.

This post is awful. Even down to the OP's username.
Just request your records and have a debrief , then a PROFESSIONAL can advise you of dosages, protocols etc.
It's not on to be accusing a midwife of being a junkie based on the information you think you know.
For what it's worth I do think there's more to this story. You know far too much about morphine administration and even drug testing.

This thread is incredibly frustrating.
So many posters telling OP to "report" a midwife for stealing and using opiates based on no evidence whatsoever. Even posters who don't think that's the case saying OP "might as well" contact PALS, as if they are just sitting idle and don't have anything else to do. If OP has concerns or questions about how her pain was managed then the only sensible course of action based on the information she has provided, as has been stated many times and completely ignored by OP, is to request a de-brief. This will give her the opportunity to see her notes, confirm that the timeline of events in her mind is accurate (anyone could be forgiven for getting a few details confused after giving birth, even with a perfectly straightforward delivery!) and then decide whether she wishes to complain about her care.

There are so many things that don't add up here. I am baffled as to how OP and her DH could be so adamant that the Midwife had "pinprick pupils" and an abnormally slow gait and yet neither of them remembered this until 6 weeks afterwards and it went unnoticed by any of her colleagues. I am equally baffled as to how the OP was (she insists) given medication in a 10ml pot- I have never, ever seen a 10ml pot in any of the settings I have worked in and I have been a Nurse in hospitals and community teams in several different trusts, including working with children. As other HCP's have pointed out, the medication pots are 30ml. There are several other details in OP's story that don't ring true or just plain don't make sense (perfectly reasonable given the situation!) but these have already been pointed out.

But for argument's sake even if OP is absolutely spot on about the exact timings and dosages of each medication she was given, exactly what was written on her drug chart, everything that was said to her by the various different HCP's she saw and the exact timeline of events (which frankly would be nothing short of amazing given that she had just had major surgery with GA, was in agony and had suffered massive blood loss) there is still zero evidence that the midwife was stealing her meds for her own personal use. It is much more likely that a genuine mistake was made. It is much more likely that someone was lazy, or that communication was poor. The fact that OP will not accept any other explanation as a possibility and is so certain that this midwife was stealing her medication for her own personal use is frankly, bizarre.

PP who claim stealing drugs and using on duty is "rife" among HCP's don't have a clue what they're talking about. It happens yes, but rarely and when it does it's a big scandal, the police are informed, it's not "swept under the rug" as some sensationalists on here claim- there are procedures that simply have to be followed. On rare occasions when HCP's do steal meds for their own personal use, they would almost certainly take them directly from the ward stock. So much simpler and less risky than what OP is alleging, which wouldn't even allow her to steal the amount an addict would need to get high enough to display the effects OP claims she and her DH observed.

I agree with @Lamkin
OPs thinking is quite frankly, bizarre. I think there is an underlying issue here to do with drugs. I wonder if there was already social service involvement and the doctors and midwives probably picked up on OPs fascination with exactly how much and how frequent the morphine was, and her paranoia.
If its not drugs related, then I wonder if it is mental health related.

If not, then why will OP not request a debrief and wants to get straight to accusing/reporting a midwife with zero evidence except her bloody "pinpoint pupils" (why is OP so familiar with these?)

And why is OP so hysterical and irrational?

And yeah, there's no 10ml pot. Do you know how tiny they would be? The med pots are standard and they are 30ml.

I had morphine when I was in with kidney stones, I couldn’t tell you what my name was let alone how much morphine or how many times I was given it!

Medicine pots are 30mls. There are no 10ml pots.

To be fair going to PALS isn’t ‘reporting’ the midwife, it’s a liaison service between the staff and patient, it’s just the first step into asking what happened. I think this would be the best solution to this- if I was a midwife I’d want the opportunity to clear my name, and if she is guilty for all the accusations the OP has made, she should be reprimanded. Like I said before, if your brave enough to come on mumsnet and report such experiences, there really is no excuse for not taking it further if other mothers/babies are at risk.

You are grossly incorrect when stating that drug abuse Is rife amongst HCP, it shows poor understanding of exactly how difficult it is to steal controlled drugs out of the cupboard.

I had a post partum haemorrhage and had to go to theatre. I was having platelets squeezed in on the way to theatre, but not after. Once I came out of recovery, I was on an intermediate ward next to the theatre suite with my DH and the baby was in the nursery.
Neither a DH or a baby will be in recovery with a woman who has just been brought out of theatre, and if that woman is still haemorrhaging she will still be in theatre. Because she's at risk of bleeding to death!

I think you should make a complaint. The NHS do cock up frequently. I think this was either a cock up or maybe the morphine meant you forgot some doses etc, morphine can zonk anyone out.

I think there are easier ways for staff to steal med than to take them from a patient while in hospital where they can be seeen. I think usually they just take them from a cupboard or something IDK.

But I think you should report it just in case- maybe you're right that the wrong dose was given or she was stealing the meds, and it'd help some other patient.

Medicine pots and cups for cup feeding are all 30mls, they don’t do 10mls that I’ve ever come across

Neither a DH or a baby will be in recovery with a woman who has just been brought out of theatre

Honestly that's not true! Not in my (NHS) hospital this year. Admittedly it was a theatre reserved purely for maternity use but they had to send me to "recovery" due to needing extra monitoring, we went straight there post csection and baby & DH went with me the entire time, alongside midwife & the anaesthetist and some others who I barely noticed.. I think they were both there the entire time with me, DH and baby but other staff were popping in for checking... But DH and baby were with me, that's the key point. If there had been complications they did warn that DH may need to leave with baby and go up to postnatal, but thankfully their concerns were unfounded and I turned out fine.

So your statement honestly isn't accurate.

I think that the chances of that being true are so infinitesimal that instigating that horrendous level of stress on the NHS employee is bordering on malicious.

Neither a DH or a baby will be in recovery with a woman who has just been brought out of theatre

It’s common practice that partners and baby’s are allowed in recovery with woman once they come out of theatre.

OP this is an awful thread. Im sorry for your pain, and im sorry it wasnt managed effectively.

However posting on MN accusing your midwife of stealing your meds is awful.

Discuss it with the hospital and ask for a meeting. Please treat this accusation with the seriousness it deserves

Medicine pots and cups for cup feeding are all 30mls, they don’t do 10mls that I’ve ever come across

They don't, it's to prevent drug errors. Eg if you give 10mls in a 10ml pot it would be filled to the top. If the next time you administer it you use a 30ml pot without realising you could inadvertently administer 30ml by filling it to the top.

There are too many errors in the ops memory to assume that she has remembered everything else accurately.

As has been said hundreds of times it seems, request a debrief and go through your notes. Ask to see whatever documentation there is relating to medication such as a drug book, if oramorph is recorded as such where you gave birth.

And re the recovery thing. IME as a midwife if a woman had a GA their husband and baby wouldn’t be in recovery with them, sometimes the baby would be brought in if Mum was alert and well but usually they were quite groggy and sleepy from the GA and so would be waiting on the ward. If the labour ward where you give birth has its own recovery (my last place didn’t, so no partners even when no GA) then I can see a DH/DP being there once mum was well.

OP, request your notes. PALS can help you with this and arranging a debrief, however I wouldnt make such an accusation until I had had such an appointment.

It sounds like you were prescribed the wrong dose. 10-20mg every 2 hours is a ridiculously high dose and takes you above the maximum recommended dose for adults. You might find it interesting that if a doctor prescribes you the wrong dose and the midwife / nurse gives it you it’s THEM who risk losing their job not the doctor who prescribed it. More than likely she realised it was the wrong dose and got it changed. 5mls every 4-6 hours is the normal dose.

Honestly I would report the facts as you see them to the ward manager / modern matron and ask them to investigate what happened.

PP are right, it's a sad fact of nursing that drug errors and addiction does happen. There may already be concerns about the nurse but no proof. I've nursed quite a few nurses through withdrawal.

I'd definitely agree you've mixed Ml/Mg, you'd not be Px 20mls a dose you'd be off your tits.

Oramorph is not a controlled drug and therefore it's not mandatory for double signatures and it comes down to individual trust rules. My local trust considers it a drug liable for misuse and therefore does require double sign offs.

I wouldn't think much about glazed and dodgy pupils. That's me on my 4/5 night shift. Wired from caffeine and surviving on 4 hours sleep for 6 days. That's also a reason it could have been an error rather than a deliberate siphoning.

Neither a DH or a baby will be in recovery with a woman who has just been brought out of theatre

Well that’s total crap, I was with my sister 24/7