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?

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

All trusts are different, some trusts allow partners and babies to be in recovery with the woman. In the trusts I’ve worked there’s even cots at the bedside.

Get your notes and a debrief OP.
you may be remembering things incorrectly or you may be right we weren't there and only by going back over the actual details will you get any peace.

I believe the main issue here to be the fact that your pain was not controlled and for that reason i do think you should have a debrief

I had similar after giving birth (minus the issue over the discrepency of medication administered and the drug abuse questioning) was in severe pain but was also confused because of the pain, but was able to keep telling them i was in severe pain off the scale worse than labour and instead they kept trying to suggest i was having mental health issues, contacted the on call psychiatrist and was questioning DH did i have prior mental health issues which i did not !

The following day a lovely doctor who had seen me through a lot of issues during that pregnancy and previous pregnancies she believed me about the pain and was able to get me some alternatives prescribed (an amazing suppository) and once the pain was under control i was no longer confused and was able to function as a perfectly normal human being

What is not ok is that women are having to jump through hoops to get the pain relief they require. Pain is subjective to each individual and while i would normally consider myself with a high pain threshold on that occasion i was in severe uncontrolled pain and all i needed was someone to control that pain and make me comfortable and not question my mental health as a reason for rolling around in pain !

Read old's post. So you had a midwife stealing your drugs, in a ward full of HCP's when you've just had a traumatic experience and are in a lot of pain and it's only you and your DH who realise (some time later) that this midwife had odd pupils and was acting strangely? Ask for a debrief. Really, if you'd had a conversation at the time about it that's one thing but you both just happen to remember she had pinpoint pupils later on with all the stuff you had going on at the time? Please OP, look after yourself and ask for a debrief. If it doesn't answer any questions then you must complain, but get the debrief first.

I'm with you there, Heinz.

Put in a formal written complaint about the midwife stating what your recollection of events is. It will be difficult to prove but as others have said it it will alert senior staff to the possibility that they have a rogue employee so they can monitor closely.

As an aside my anti depressants give me pin point pupils.. hope that doesn't make my patients think I'm stealing drugs!

I really think you need to speak to your HV/GP about a debrief about your whole experience as soon as possible. Your partner may also well benefit from this too so you can support each other through this.

An emcs is a frightening situation for all and I'm surprised you've not been offered the opportunity to discuss this, especially considering MH services were contacted at one stage.

20mls I.e. 40mg is a massive dose to be written up 2hrly. Especially for someone without any tolerance.

I think your numbers might be out of whack somewhere here.

I would still write a letter of complaint to PALS though, it’s not appropriate to fucking gaslight you without even investigating your allegation about not being given the drug. Like you need the trauma of a further 5 days admission on top of the surgery you’d already had!

@Perunatop, that is literally the last thing that should happen, going on the details of the OP. It would involve traumatising a hardworking midwife and her family before Christmas by putting a bomb under her career, when it is manifestly extremely unlikely to be warranted.

What is required here, as umpteen posters have indicated, is a proper debriefing for a complex and upsetting birth experience. Not a sledgehammer being taken to a nut.

Jeebs, who'd be an HCP if this were the protocol?

I'd have thought a midwife with an opioid addiction bad enough to steal mid-shift from a post-surgery patient would a) not get much out of the dregs of your prescription b) not appear visibly high c) not bother with this approach and take it in a bigger volume from the source

This sounds awful and I'm sorry you went through it. But I think confusion, pain and tiredness on your part are a more likely explanation.

Are you sure you weren't out of it? How did you know what was administered? Morphine is a powerful drug. I seriously doubt the nurse stole your meds.

Why if you were going to steal drugs would you steal from the patient who says herself obviously checked what and the amounts she was being given. And if you did steal one dose then realised that the patient was checking and making a noise about it would steal a further two doses makes absolutely no sense.

Put in a formal written complaint about the midwife stating what your recollection of events is. It will be difficult to prove but as others have said it it will alert senior staff to the possibility that they have a rogue employee so they can monitor closely.

I can’t believe the casual way in which posters are advising the OP to complain about a scenario that is extremely unlikely to have happened. OP was going through a traumatic time, has already made a mistake with the drug dosages she thought she should have/has had and after some weeks has put two and two together and made three hundred and sixty-eight in the ludicrous belief that her midwife had pinpoint pupils.

Do you not realise how traumatised the very probably innocent midwife will be as a result of this madness? It’s not enough to say if she’s done nothing wrong then she has nothing to worry about. She could be suspended from work or have her practice restricted. She may be frantic at the thought of losing her job and her income because believe me, if you are accused in this way you have no faith in the fact that you know you’ve done no wrong. You fear the worst. Ultimately, even if exonerated she could be forgiven for leaving the profession altogether.

10ml medicine measuring cups literally don’t exist

Anyone casually suggesting the OP reports the midwife has clearly never worked in healthcare. The fear that midwife would go through after this accusation (even if proved untrue) would be unreal. An incident like this could force her from the profession.

The OP has a right to complain that her pain was not managed correctly and request a debrief but pointing fingers at a probably innocent midwife is not the way to go.

Unless UK is completely different to Australia (which I doubt). Morphine and other schedule 8 drugs are kept in a double locked cupboard and documented in a register. They are counted out by two registered nurses and administered and checked by two RN’s as well. Maybe 20 years ago people were less lax but not now.... some drug cupboards are activated with thumb print scanners, Others using staff members swipe cards as access keys. Just doesn’t seem logical what you are proposing OP so a debrief explanation would probably be very helpful to you.

And if painrelief was not appropriately and adequately given then perhaps further education or review of care is needed which could be flagged in your debrief

Have you seen the series Dirty John on Netflix? He did what you have alleged. The patient had just undergone a surgical procedure and he pretended to give her pain relief so he could steal it.

Starstruck-As many others have said in the UK some trusts have stopped managing oramorph liquid as a CD. It's almost certain that the prescription was on the PRN (as required)side of the drug card and was written as a variable dose, e.g. 5mgs -10mgs every 4 hours. As most others have said the OP needs to request a debrief and access to her records to discuss this. Some suggestions are bizarre, random drug screening of the midwife ??

That sounds absolutely horrendous - I’m so sorry. As an aside - I found the post labour ward was every woman for herself. I’m taking in my own pain relief next time as it took them bloody ages to get round with it so I was never fully on top of my pain after an assisted delivery. Hope you’re enjoying your lovely little baby and you get some answers!

I agree that a 10ml cup would not be used - that's two teaspoons and would literally be tiny.

However it is clear that, whatever happened, you (and probably your DH) have been left traumatised by the birth and after care. I can only reiterate that the Trust can provide a debrief and should be happy to work with you to resolve your concerns. You also have the right to request your records, although they usually charge for thi. However if you request them through the debrief process than they may waive the charge.

Those urging the OP to raise a formal complaint through PALS, note that they deal with informal and ongoing concerns. Whilst they will raise a formal complaint on a person's behalf if asked to do so, many people approach PALS believing that they have made a complaint that will automatically be dealt with under the formal complaint regulations, and later find that it hasn't.

I'm so sorry you had a tough time not only during labour but also in recovery. Congratulations on your new baby, I hope you're enjoying motherhood.

You definitely should complain about how your pain wasn't managed appropriatly. It's sad they automatically assume you have a drug addiction or mental health issues when you're clearly in severe pain.
It's a shame some women just aren't listened to when they're in pain. I remember being told I wasn't in labour despite me protesting I was. No checks or anything, they just sent me for a walk around the hospital "to get things moving". I gave birth less than six minutes later in a corridor of the hospital. We know our bodies and when the pain is too much. So I'm sorry you weren't listened to.

In regards to reporting that particular midwife. I agree with others, don't make any hard and fast accusations but do ensure you put forward your facts of your side of the story. X

She could have been siphoning your oromorph but I would agree with the suggestion that you were getting mg & ml confused. The prescription will have been in mg which the midwife will have had to convert into ml to give you the correct dose. It is always advised to start at the lower end of the prescribed amounts first and work up if pain is not being controlled. So, yes, she should’ve pushed the dosage up within the prescribed allowance for you as your pain score was still high.

You can chat to PALS if it is playing on your mind.

Sounds to me like the HCPs decided: poor response to morphine, poor veins, uncontrollable pain = drug addiction/use
Obviously the wrong call In your case but they did the right thing to involve psych/SS. Awful for you.
I think personally you’ve got the drug regime confused. But have a debrief and get some answers otherwise it’ll niggle away and spoil this special time.

Theres no way you would have been.prescribed 120mls overnight!