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?

Oromorph is not a CD in the UK. Keeping it is in the CD cupboard and using the book is ‘best practice’ but not mandatory. It wasn’t used where I practiced until summer last year.

There are far too many things that simply couldn't have happened on this thread.

I'm going to suggest at best that OP hasn't got a clue what actually happened due to the combination of pain and drugs.

I'm most baffled at the part where OP is having blood squeezed into her while her DH sits and watches.

I routinely prescribe 10-20mg morphine orally Q1H (that means up to hourly) after a GA abdominal operation, including Caesar. I also give it subcut in recovery if the IV access is in use with blood (I have never understood why, since it is going into blood, nurses won’t give meds through the same IV as blood, but they don’t).

I also have the husband in theatre for a GA section and then in recovery.

OP, you need a meeting with a charge midwife, your notes and a proper debrief. A notes review will show you what has been documented, a debrief will help address the issue of why your pain was so inadequately controlled, and the process may highlight some issues with inappropriate judgement of patients as drug seekers and lead to improved education for midwives. It may also highlight an issue with the midwife on that first night shift which will help them in the long run.

Morphine gives pinpoint pupils.

(Obstetric anaesthetist)

is it possible that you were mistaking
your prescription for a Prn (as required) dose of , for a regular dose. it would be quite possible for a prescription to say 5-10mls i.e 10-20mg oramorph prn, maximum frequency 2 hourly. this does not mean you are entitled to have this 2 hourly and the nurse has the discretion not to give it. it’s a guide, and any sensible nurse or midwife would be extremely wary before even considering giving 20mg 2 hourly, that’s a huge dose for an opiate naive patient. I would not lay my pin on the line for that without checking with the prescriber first. That said your pain was uncontrolled and that has caused you distress and you maybe weren’t managed as well as you could have been, for that I would consider a debrief before throwing around accusations that could destroy someone’s career

I have nearly read the full thread. I echo what many have said and think you should go for the debrief.

OP you seem very confused about the doses, the timeline of events, and the medications you were given. As it’s infinitely more likely that as you were in pain and confused you are mistaken, why would you not review your notes and have a debrief rather than make wild accusations?

So many things don’t add up in what you are saying - you had the sub-cue, and the PCA, which you didn’t use for hours repeatedly but then pressed lots but then you had the oramorph which was over 12 hours - there’s a lot more hours here than 24 in your 24 hour story.

Also, your husband was there for all 3 doses of oramorph but not there any of the rest of the time in case they gave more - how does that work?

I really think you are mistaken and going in all guns blazing can destroy someone's career.

If a midwife wanted to steal drugs I would assume she has more than one patient so why wouldn't she steal a dose from each which makes it less obvious or you know, steal it from the bottle as others have said.

I would provide feedback via PALS. Nothing may come of it but if they receive numerous complaints that can be traced back to the same person it can provide the basis for an investigation.

I just lost a long post . So annoying.

OP, after my CS, a night shift nurse withheld my prescribed morphine. It was investigated. Also, midwife and trainee were awful about epidural top-ups. Making faces when I asked for more etc etc. Turns out it was not correctly inserted, so I didn't get much pain relief until senior anaesthiatist checked it and a new one inserted.

OP, you have been treated dreadfully after a traumatic birth and ?near death experience. Please look into PTSD and consider if you need to deal with that too?

There is malpractice in the medical world motivated by all sorts of things. I received abusive text messages from a member of staff once at home. No idea why I was cared to report that!

Difficult births are normalised. We are not supposed to share our trauma. This needs to change. Just because giving birth can be a natural process shouldn't detract from traumatic experiences.

Good luck OP.

Interesting replies which echo my own experience. Namely aneasthetists quite generous with opiates and reasonably relaxed about dosages/timings. Nurses and midwives far more cautious and keen to stick to recommended doses in BNF or hospital formulary. Neither right or wrong, but I can see how what the aneasthetist said or suggested ended up not being either perscribed (why you need to see the drug chart) or administered.

cared - too scared.

(Also I can spell anaesthetist! )

Thanks nutella. I agree about the sweeping under the table of womens' pain and trauma around childbirth. I think it is very institutionalised and not down to any individual hcp.

Perhaps this has already been says but liquid morphine comes in 2 strengths, commonly 10mg in 5mls and a stronger one which is 20mg in 1mls. Is it possible you were given the stronger version? You would have then received 5 tones more than you think you had. IIRC the stronger version is pink, but different brands may differ

Going back to the beginning of this increasingly complex and unbelievable story. I think someone might notice a midwife was 'clearly off her face'

Dosage aside, isn’t it bloody awful how post c section women are given the bare minimum of proper pain relief, then after a few hours made to feel bad that paracetamol is not controlling the pain. I find it quite unbelievable actually. It’s major surgery, and there they are 24 hours later giving you a couple of paracetamol as if you’ve got a bit of a headache. I don’t understand why - is it cost?

I’m a bit at people saying they know how much OP would have been prescribed - this depends so much on the individual patient.

I was given 80mg of oramorph every four hours after my c section. I know this because the ananesthetist and I had a detailed conversation about what would work because I have been taking morphine for a medication condition for many years. At one point 80mg every four hours was a daily thing, whereas this could seriously harm someone with no tolerance.

I’ve also had situations where anaesthetists have written up large doses for me in recovery because of my tolerance and nurses have refused to administer them because they think I shouldn’t need that much, couldn’t be in pain at that level etc. One time I discharged myself as soon as possible because the nurses were giving me less after major surgery than I took on a normal day, and I could manage my pain better myself.

I’m so sorry you’ve been through this OP, it must have been really traumatic.

Exactly Sinkgirl I think a cautious/ stingy approach far more likely than deception and personal use.

Namely aneasthetists quite generous with opiates and reasonably relaxed about dosages/timings. Nurses and midwives far more cautious and keen to stick to recommended doses in BNF or hospital formulary.

I think a lot of this comes from the fact that when a doctor gets something wrong they all really around each other and support each other. A nurse/midwife gets something wrong and the NMC throws the book at them.

Its also worth remembering that a doctor writes the prescription up then that it. It's the nurse that administers, see the effects and has to make the judgement calls about it all. I've had numerous occasions where I've refused to give out medication that doctors were a bit liberal in prescribing when it was clear the patient wasnt getting on with it/abusing it/ just didnt need it (mental health nurse so granted a different client group).

OP I echo other in getting a full debrief and going from there. Some things just dont seem right. Your DH witnessing blood being squeezed in is strange, presumably this is an emergency situation ie the sort of situation where relatives are very quickly cleared out to let people work????

OP Make sure you take someone with you to your debrief. Don't go alone. Either Dh, or a skilled friend to take notes, ask poignant questions.

Mine wasn't a medical one, a different kind of complaint, but my friend, an employment lawyer was fab. I think panels treat you differently when you have a witness with you.

Yeah. Take a paracetamol. Nurses telling you that you can't be in THAT much pain. No. You're right. I'm just making it up, for a giggle.

I know Formerly as I said neither right or wrong. I have had a post op patient arrest on the ward after giving IV morphine on anaesthetist's instructions, so caution is sometimes necessary

Post caesarean I was off my face on drugs! Whatever combination of meds I had, it made everything a bit fuzzy and I'd see staff days after who'd been in theater or seen me soon after that I didn't recognize.

Not saying you haven't had a bad time, but its worth asking for a debrief to go through the details of what actually happened. If this highlights issues, you can then ask for it to be investigated.

And we are still here...

We see things not as they are but as we are...

Get the full debrief to find out what was done/said & why.

Lot of armchair/keyboard hcp assumptions being made. Actual hcpsndamned if the do, damned if the don't.

I am really getting pissed off at the number of people taking offence at the OP/themselves being asked about their prior mental health.

Acute post partum illness in the immediate hours after birth is a very serious condition. The reasons for it are complex, but are thought to relate to sudden hormonal change. Whilst rare, it is more common in traumatic births and women with some prior mh conditions. Symptoms can include psychosis, hallucinations, disassociation, aggression, detachment from reality.

Similar symptoms to reaction to morphine.

Essentially in asking the question 'any mh/drug history?' the hcp are asking, perhaps in a clumsy way, is this normal behaviour for the patient, or are they acting under a mh conditions, or drug reaction?

If the hcp got it wrong, didn't intervene & OP did have post partum psychosis that could end with inpatient stay at mother and baby unit miles away...or worse.

For years, there's been criticism about a lack of interest in perinatal mh. Now women are asked, it's still not right! Make up your minds. Sometimes, Methinks the lady doth protest too much*

*itsoktonotbeok

Absolutely quite possible

This happened at the time my sister and I were in hospital

Guernsey midwives struck off over baby deaths www.bbc.co.uk/news/world-europe-guernsey-41435467

This was amongst other things that were happening on our labour/ maternity ward.

Thankfully all has been sorted now and the ward is considered excellent

Jesus is this thread still running? Ask for a copy of your medical notes and a meeting with PALS. Do not mention morphine stealing but say you want to talk about your recovery. Look at the drug chart. I expect it will all become clear, no need to point fingers at anyone and you can be reassured and move on. Sorry you had a tough birth and recovery, hope all is well now.