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 recommended dose is 10mg-20mg (which is 5ml-10ml) every 4 hours but you’re saying you were written up for 20mg every 2 hours? I think you need to request a debrief because that cannot be correct, the dose is enormous and way above the maximum daily dose. You clearly had a traumatic experience with your birth and I hope a debrief will provide some clarity and help you begin to understand.

I do not doubt that this could have happened, but I am not sure how, when In so much pain you were so aware and certain of what was happening.

Oramorph is checked by two qualified staff because it is classed as a controlled drug in most hospital trusts . It is usually dispensed as 10mg in 5 mls . How was the oramorph offered to you ? In a pot or syringe?

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

That sounds about right, it’s 4-6 hourly through the night and you had 10mgs each time. That’s about what one would expect after surgery.

You're not a redhead are you OP, the main gene for red hair makes you more sensitive to pain and less sensitive to anasthetics?
As the PP said you may be unfortunate enough to be less sensitive to morphine
I've never had any major post natal mood disorder but I've had three babies ( including a CS under GA) and each time there has been a least one period of time that is remembered in a strange dreamlike way, due to painkillers, tiredness and hormones. Once I also experienced post natal euphoria where I was so excited and happy that I organised a Christmas drinks party for the neighbours the day after I got home ( two days post forceps and masses of stitches), I also got the GP out to baby who I thought was breathing funny ( he wasn't). I felt very happy but wasn't 100% rational now I look back...

My hospital only actually gave me paracetamol after a csection so I am quite surprised at the amount of morphine quoted here. I think it was probably due to confusion but you could contact Pals and see what they say.

I think bearing all your posts in mind and what other experienced posters have said I think it’s possible that these thoughts are related to your mental healthy emergency OP. I think you’re going to struggle to get this resolved.

I had a morphine pump after a emergency c section under general anaesthetic, I pressed for more pain relief. The overnight midwife advised me to stop using it as I'd be in the ward longer.
I don't remember much about when I had the morphine it was very hazy. I would be wary about accusing a hcp of stealing and using your morphine.

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.

If she is innocent she won't lose her registration or her career, because there will be no evidence to support OP's assertions.

Hi I use oramorph constantly for my patients 10mg is 5ml so it’s standard to give 2.5 to 5mls anymore is rare . I’ve given 10mls once in a very large overweight man so I think you have confused the mg/mls

I worked on a Gynae surgical Ward for many years and when patients came back from theatre and were high from the anaesthetic and pain relief, they were often very confused they couldn't tell you what time of day or night it was all they knew was they were sleepy and in pain, they had no idea who spoken to them what had been said or if they had recently been given any pain relief. They would often think that their catheter haven't been emptied or that they haven't been allowed any water but in fact their water jug was there and I had often helped them have a drink of water, and their catheter been emptied regularly. then we can set been checked they would often say they haven't slept at all during the night but yet when we went in to check on them they were snoring their heads off, it seems to be a common side-effect of strong pain medication. I'm not saying that that's what's happened to you but I worked on that ward for over 15 years and saw it time and time again.

I am confused although sure what you are saying is correct about the administering of oramorph in hospital but when my dad was at home suffering with cancer he had a bottle of the stuff at home which we were allowed to give him before he was changed to the philals of morphine which were in a locked container and administered only by the on call doctors/nurse

@icannotremember

OP had major surgery and was on a huge amount of pain relief, she cannot correctly recall the doses of medications. She sounds confused which is totally understandable. With that in mind, it’d be wrong to blindly make an accusation and I don’t understand why some people are supporting this.

If OP has a full debrief and access to her notes, then she can make a decision but saying to report a midwife based on this is just bizarre and people should be supporting OP to get the facts and not doing the MN favourite thing of reporting someone to everyone and anyone. It does affect professionals, even if it is a totally mistaken accusation and it’s a huge thing to do to someone without any evidence. Perhaps this nurse was sloppy and charted things poorly? Obviously this massively needs pulling up and dealing with but accusing someone of stealing morphine and working while on morphine with no evidence is a huge thing to do. OP has clearly had a traumatic birth and difficult recovery, she needs support not cheerleaders yelling “report, report, report”.

The pump will only administer the prescribed dose, but if you keep
Pressing it it will alert staff that you’re still in pain. They do try and keep you in longer if you have more pain relief.

As I say I have had 2 similar deliveries one very recently and I did have to fight for pain relief but Ops post really doesn’t sound right. Especially deciding it’s “so obvious”
Her morphine was being stolen. I’m
Not surprised the staff thought you were a drug addict tbh

this was 2007 so maybe the laws on administering oramorph have since changed

I think you were very confused, a GA, sleep deprivation, blood loss and opioids will do that.

After a surgery 2 years ago I was convinced I wasn't being given enough painkillers too. GA's majorly affect my memory and cognitive ability for 48 hours afterwards. I've had full conversations that I've completely forgotten.

2 c sections and other surgerys and I have never been given painkillers such as morphine on a 2 hourly basis. Surely that would be an overdose? Painkillers every 4 hours sounds about normal. Oramorph made me ridiculously out of it so you could be misremembering. The initial dose given by the dr is likely to be different to what was the prescribed for on the ward.

I agree with you shyuler but also the op shouldn't have been accused of being an addict and threatened with SS

@icannotremember ah yeah, you're right. If she's "innocent" (which she clearly is) then she won't feel any undue stress that goes alongside being falsely accused and investigated. Yeah, you're right.

I'm a nurse. As others have said 20 mls of oromorph is a huge dose, even 20mg (10mls) is a lot. Maximum I've given is 10mg (5ml) every 2 hours and that was for a heroin addict, so highly unlikely you'd be prescribed 20mg 2 hourly.

Honestly the best thing to do would be to ask about a debrief - it seems it was a complicated delivery and recovery and with a debrief you can see exactly what happened/what was given. At this point you’re trying to remember through imperfect memory what happened weeks ago in the middle of the night after major surgery under GA while you were in pain and no one's memory is that reliable.

AIBU or was midwife stealing my morphine? To answer your question YABU to accuse her of anything until you have some actual information as opposed to vague memories.

To the previous poster that said that nothing would come of a complaint if the midwife is innocent - there would need to be an investigation, while there is an investigation it’s likely that she won’t be able to administer medication which would significantly impact on her ability to deliver care to women on the labour ward.

I noticed she looked glazed and was acting weird but didn't put 2 and 2 together. Were it not for the large discrepancy I would have assumed tired.

Nurse friend says it's very common and often not noticed by busy colleagues.

I am positive I was given 5ml 3 times, no more.

Subcutanious was in recovery, no idea of amount, DH just saw them do it. I wasn't entirely conscious at that point, so superfluous information. Sorry.

I am certain, beyond a shadow of a doubt that 20 (I accept probably mg not ml) was recorded every 2 hours on my chart, 6 doses. Numerous people saw this. I am also positive I actually had no more than 5ml (so 10mg) no more than 3 times in this time period.

DH witnessed all 3 doses, was told more given in his absence. He isn't quick to dramatise and usually convinces me to let things go for an easier life.
He is sure it was misrecorded and fairly insistent that we should report it.

OP, I think you should complain. Not about any theoretical stealing of your drugs, but that you were left in severe pain overnight with no explanation or assistance.

Not only did your healthcare providers fail to listen and take appropriate action, they appear to have implied that your reaction was due to a mental health problem, or that you were lying.

As Moondust states above, oral morphine does not work for everyone. If this was the case for you, and you made it clear that you were in extreme pain, the correct action would be to call an anaesthetist.

The original anaesthetist had correctly stated that preventing pain from beginning is much easier than stopping it once the pathways are triggered.

Instead, your word was doubted and, from the sound of it, belittled. This is unfortunately very common in women’s healthcare.

It may be that there was no other pain relief that would have been safe if you were breastfeeding. But that also should have been discussed and if that was the case, it should have been explained.

So I think you should complain. My advice, assuming your husband is onside and agrees with you, is to take him. The sad reality is they are more likely to listen to his evidence than yours.

Best of luck.

This sounds like what must have been a total nightmare. Gross abuse of power from the midwide if it’s true what you suspect and also quite unprofessional from hospital staff that nobody took the effort to ask you some more questions but it was simply assumed that you were in a mental crisis .

I would definitely take it further. If this had happened to me and I could prove it, would also have sued the hospital (but maybe that’s not a very British thing to do...).

Good luck OP

I agree with a pp that the hospital staff shouldn't have been accusing you of being a drug addict. Confusion is a very common reaction in your circumstances, they should have been more understanding.