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?

I am sure the midwife wasn't taking your opioids. Maybe oramorph didn't work for you? It doesn't for everyone.

I think you should ask for a debrief to go through all of your notes with someone because, in the same way you have got the dose wrong, there may be other things that you aren’t remembering and it will help you.

I’ve had four c sections inc under a GA and another where I’ve haemorrhaged and had major complications, and not had more than two or three doses of oramorph in total. What you think you were prescribed was dangerously excessive.

5ml is 10 mg though that’s the concentration
Adults:
Recommended dose 10-20 mg (5-10 ml) every 4 hours.
Maximum daily dose: 120 mg per day

For your pain 10mg so 5ml was correct.

To clarify, I have had oramorph before, including in the last year for surgery. I needed the upper end of the dose then too.

It was a high initial dose, no denying. They administered sub cuabeousy

My immediate thought was you've got mg and ml mixed up, easy to do if your not experienced with medication dosages.

She gave me 5ml of oramorph very infrequently - every 4-6 hours over the night, despite my frequent buzzing in absolute agony

This comment stood out to me OP.

Every six hours would have meant she administered the oramorph once during the night. Every 4 hours would mean twice maximum. But you seem under the impression it was several times. You say “every 4-6 hours” there wouldn’t have been enough hours in the night for that to happen. I think perhaps your tiredness and pain have led you to be confused about the timings and probably the dosage too.

Sub cutaniously as I was coming round. I had a massive bleed - mutiple litres, serious internal injury. Dr was happy for me to have a high dose as it was managing pain

Doing the ml's to mg's conversion, I was given 60mg over a 12 hour period in 2-3 hour 10mg does and this was deemed to be controlling the pain and it was. I had my son at 3:30pm, first dose was around 6pm and continued until 6am. I never had any after that, just paracetamol. It was suggested to have 20mg every 4-6 hours instead but I refused and said 10mg every 2-3 hours (preferably 2) was good. I can't see a doctor saying you should get 40mg every 2-3 hours? Wouldn't you overdose? You can only have 140mgs every 24 hours and I think they like to only keep you on it for short spells like 12-24 hours post op unless you have a chronic pain condition?

I am not convinced that anyone in that much pain can trust anything they "observe" - you clearly didn't understand the dosages, so I am doubtful that you could observe the symptoms of a "high" in someone that you didn't see very much of. However, I can offer another answer, which is possibly far more likely. Although it is not common, not everyone reacts to morphine in expected ways, and it has been explained to me that oral morphine can be far less effective than that delivered directly into the bloodstream. For some people morphine has little or no effect when it comes to painkilling - I am one of those people! Morphine simply does not work on me. The consultant who told me about this said that it is often an inherited trait, and my father had, after surgery, also complained that the morphine wasn't working but nobody believed him at the time as this particular trait wasn't known about at that time. For some people, too, morphine can actually increase pain rather than manage it. This is a far more recent discovery - some people being "immune" to morphine has been known for a bit longer, but the effect of morphine increasing pain in some people has only become known in the last decade, and I don't think they even know why yet.

It is just possible you are one of the unlucky ones. Whilst your version isn't impossible, it does seem unlikely given your confusion about things (which is understandable) and the fact that whilst HCP's may be as prone to bad habits as anyone else, it seems rather unlikely that she would steal your meds and take them whilst on a shift with a lot of medical professionals around her who are likely to spot the signs!

When I had oramorph it was name checked against my bracelet thingy and then given by a pre loaded pipette by a staff nurse and a hca.

@iworkatthecheescakefactory over 12 hours 8pm-8pm I had one 5ml dose administered at 10pm, 2am and 8am or there abouts

I would definitely go for the after thoughts session at least.

I had a midwife accuse me of being a drug addict for asking for more codeine on day 5 post cs. She felt I shouldn't need any pain relief. I was up every 2 hours caring for dtds in scbu and was in so much pain. Turned out I had an infection but rather than considering that she jumped to drug addict (I promise I don't look like a drug addict). It was the midwife's last week before transferring. I was lucky enough to have the scbu nurses on side who comforted me. The sister marched out and confronted the midwife who admitted saying it (in front of a ward of mums and their partners). I'm still angry now.

It may or may not be a mix up. Get pals involved ASAP and ensure they check for an infection.

Are you sure you’re not getting mls and Mgs confused? 10mgs of morphine is 5 mls.

This. And I've had loads of morphine, so I know where you're coming from in that you expect the higher dosage and can handle it, but I expect you've misread the amount.

I’ve had the same delivery Twice and I will say that midwifes can be tight as hell with drugs. I don’t understand why there was only one midwife administering a controlled drug though.

Regardless of the accusation of the midwife you have every right to complain to PALS and ask for your concerns about your pain medication to be investigated. You can request your notes and have a meeting where they can bring in the dosage cups with lines on and talk you through how much you should have had and how often vs how much you remember being given and how often. It is perfectly possible the midwife stole the medication and doctored the medication charts. It's also perfectly possible you misunderstood the dosage and frequency. I'm not saying either is right but you are entitled to ask for an investigation that gives you reassurance either way. I was lied to about oramorph and told I couldn't be discharged with it. That's an absolute lie as people are and were around the time I gave birth. So midwives can and do lie about oramorph. Different circumstances granted but I believe it's possible for midwives to lie but also possible you misunderstood.

So you had 3 doses in 10 hours. Presuming you came off the pump at 8pm so had some residual pain relief from that that took you to 10pm.

OK so the dose from the doctor isn't comparable at all as it is subcutaneous, the doses are entirely different to oral and so we have no idea what it was. It may also have looked bigger if it was diluted with water or saline to make it easier to draw up, or have had other drugs in it like an anti-emetic.

All the rest are oral, and if they are at 10, 2 and 8, and came spontaneously from the midwife, not you pressing your buzzer asking, those sound very much like times ringed on the drug chart for her to bring it. And that would be normal prescribing for 10mgs 6 hourly.

Accept probably confused ml and mg on chart. This still means I was given a quarter of what was written.

If both you and your DH noticed the pin point pupils in the midwifes eyes, how didnt the rest of the medical team notice she was so drugged up?

Request a birth debrief, it’s really useful to talk it all through. And at my hospital it’s always with a head midwife so I’m sure if your talking it through and disagreeing theyl be able to advise you if they think it’s suspicious. And if it somehow adds up when you talk through the notes then you have a little closure. I found it really useful

I hope you do report this Op, its an awful thing you went through and it could stop someone else going through it.

I had experience of the reverse, when my dad was terminally ill and in pain we called the out of hours doctor who gave him the whole phial of morphine rather than 1 tenth, so in effect 10 times the dose, his pain stopped and he died shortly afterwards. The doctor who came out wasn't from our area as they covered a large range during the night at that time, he said "you poor poor man," and gave him the morphine. He was close to dying anyway and alhough we mentioned this to the hospice the following day when he was admitted as he was unconscious (didn't come round following the dose) no more action was taken and I believe the Dr acted in my dads best interests, but your situation is very different the midwife if she was stealing it was doing it for her own interests and addiction and causing you undue pain and distress.

I hope you get some resolution to this.

I do not believe that a midwife would be 'off her face' on shift and you only remembered this a few weeks later.

I definitely think you need to talk this over with someone and discuss your concerns, but I think it is highly unlikely a midwife was stealing your medication.

Congratulations on your baby

As others have said 20ml of oramorph is 40mg, which is a very very high dose. It's highly unlikely this what you were prescribed.

I think what may have happened is the anesthetized told you what you would get, but the Dr who does the prescribing wrote down different to what he said. I see that happening all the time.

Also, in my trust on our drug charts, oramorph is given as required only, so you need to ask when you want it. So many patients complain that they didn't receive pain meds but they didn't ask for it. Nurses aren't to know when you need more. Before you go accusing a nurse of drug misuse I suggest you find out exactly what happened. If she is innocent then you could ruin her reputation as a nurse and she could lose her registration/career. I would be mortified if I was ever wrongly accused of this because of a misunderstanding.