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 absolutely recommend a debrief If nothing else as clearly for it to get to the point of your MH being questioned and the threat of SS, it can't have been pretty and I'm sure you'd appreciate an opportunity to talk this through

@Passthecherrycoke because over 12 hours id only had a quarter of the max dose, not half. I understand starting on a lower dose, no problem with that. There was room for the dose to be increased when the pain wasn't being managed, but obviously it couldn't be increased because the misrecording stated I'd already had 24hrs worth.

I'm not saying I should have had the 24hour max dose overnight, I'm saying that's what it was recorded I had. And as a result of this suspicious discrepancy, pain relief that should have been available to me the next day was not.

Sorry but I just don't get why you were apparently prescribed the max dose following a section? Just doesn't seem right. I know the dose my FIL was on just before his death and can't imagine the pain is comparable. I've had a section, I understand. It's really grim. Especially after a complicated birth and as an emergency measure. But for you to be prescribed the top dose right off without a review- why?

Unless you are going to contact the hospital and ask for a review of your notes there is nothing else to discuss. I work in a hospital. I regularly get calls from pharmacies double checking prescriptions because doctors have written them wrong. Written incorrect dosage, incorrect name. Mistakes happen and many people have explained that what the consultant told you you would be getting was actually an overdose. Maybe someone noticed the discrepancy in the chart and the doctor represcribed. Mistakes can happen and doctors are as likely to make them as nurses are.

The only thing you can do is ask to review your maternity and postnatal notes. From there you can decide whether to lodge a complaint or not.

Ok I get what you’re saying. You weren’t prescribed the maximum dose overnight, the nurse / midwife has recorded that she gave it to you- presumably saying that you had consistently asked for more than the prescribed dose and she had a decision to increase it based on that?
Even though as you say, you believe you were given less than both the prescribed and recorded doses

Oramorph is 10mg/5ml so you were given the correct dose as prescribed. Oramorph is not a controlled drug so does not need 2 nurses to check in most NHS trusts.
I'm sorry you were in pain but accusing your midwife of stealing your analgesia is, frankly, fucking ridiculous.

@passthecherrycoke I would have been able to have, for eg, 10ml (20mg) every 4 hours so 6 x 10ml, or 5ml (10mg) every 2 hours, so 12 x 5ml.
Rather than 3 x 5ml then being told I've hit max dose and no more pain relief, and that I'm a drug addict for finding 1/4 of the drs recommendation insufficient. I was given 1 full 10ml cup at the end of the initial shift after coming off the pump by a different member of staff, so it was an option. That was also dispensed by a sole member of staff so presumably one person can dispense alone now.

What you need to remember is there’s a max daily dose of morphine which is 120mg.

You will have received some IV at a dosage of approx 10-20mg post delivery, and from what you’ve also mentioned is that you also received some IM once in recovery which would have again been 10-20mg, then we’re given a morphine pump for you to administer your own which I’m assuming you had for 12 hours. Then you’ve had approx 4 doses of 10mg in the next 12 hours which will have taken you to the max dose.

Every women recovers differently from a CS, if your pain wasn’t being managed by the morphine the midwife should have asked for a doctor review especially as you couldn’t manage to get out of bed, so that alone you could contact PALS as the midwife should have sought a dr review due to the amount of pain you were in.

Whether the OP is wrong or not about that nurse. The fact is that no one should be left to be in that much pain.

To warrant a mental health questioning? And a possible SS intervention?

What does your husband think of all of this OP?

Speak to PALS?

There is something just not right here.

One woman may be able to cope with minimal pain relief.

What is the view? If another woman can't cope? Even on what a Doctor believes she should be able to?

I rarely take pain killers. But when I am in pain, I need a lot. More than you? So how do we all deal with that?

In the trusts i’ve worked at all medication is checked and countersigned by another registered midwife before given to women. For oramorph, once it’s been dispensed the remaining amount in the bottle is also documented in a controlled drugs book before it’s countersigned and given to the woman.

I was given 1 full 10ml cup at the end of the initial shift after coming off the pump by a different member of staff,

Medicine cups are 30ml, not 10ml, or they were when I was nursing.

You can't have been given 30ml

Most women go home on day2 after a section. The stinginess with the pain killers may have been because they were expecting you to be discharged. Most women have 1 or 2 doses of morphine post section, not 4 or 5. So your pain relief needs were outside what they were expecting. It is highly unusual for patients to be so interested in dosages of medicine- especially opiates, that would ring alarm bells for me.

I think from what you’ve written your complaint is that your pain wasn’t managed appropriately, and that should have triggered a doctor review before any concerns of your mental health were raised.

So, the best thing to do would be to contact PALS about not receiving adequate pain relief which then impacted your mental health.

Absolutely complain. Every single shitty midwife needs removed from their jobs asap. I also didn't complain about my treatment (much better than yours, mine was just rude and manipulative- at least she wasn't stealing my medication), but next time I absolutely will. We need to defend ourselves.

@Blahblahblahnanana has hit the nail on the head. You would have had multiple different methods or morphine (pump, sub cut and oral) which likely would have taken you to the max amount you could have in 24 hours.
In most trusts, including mine, oromorph is not a controlled drug, and it's kept in our drug trolley to administer as and when needed. If the nurse was administering this on her own, it's not a controlled drug in her trust. The nurse in charge would be the only one to hold the key for the CD cupboard. If she wanted to steal oromorph, she could have done it straight from the trolley, no need to take yours.

I think the likely scenario is that you had almost reached your limit of morphine through the different methods you have described.
Having been taken off a morphine pump, and given sub cut morphine which i would expect to last around 4 hours depending on dose, and three doses of oromorph sounds completely reasonable.

However, if you were still in severe pain and there was no explanation as to why you could not have alternative pain relief, i think you wouldn't be unreasonable to complain about that.

But i really don't think the midwife was stealing your oromorph.

Legally oramorph is no longer a CD. Some units may still treat it as such but the legal requirement for 2 trained HCPs to check & administer it have been removed.

www.google.com/amp/s/www.bbc.co.uk/news/amp/uk-england-lincolnshire-43433570

It happens

Cups are 30ml which would have been 60mg oramorph if it was full
10mls in a cup 2ould have been 20mg oramorph
Oramorph is not given by subcutaneous injection, you would have been given morphine which is stronger
Oramorph is not given via a pump, that would also have been morphine
It might not be double checked, it often isn't in hospitals
Why would the nurse steal it from you, if it's not locked up she could take it anytime
Ask to see your drug chart and what the nurse wrote in your notes
Pharmacy can easily calculate how much was given, they can look at the stock level against what they gave the ward and work out if there is a lot missing
If the nurse was stealing it and taking overnight how could you see here pupils
Pupils go smaller in daylight and sunshine

Could it be that your drug chart was changed? A pharmacist may have spotted 2 hrly morphine as incorrect (it's usually 4 hourly minimum), spoken to the Dr and had it amended?

First thing I would do is request your medical records and go from there. But if your sure , put it all down in writing and submit to the relevant people.

Plus, oramorph is still a controlled drug, but it's schedule 5 which means it's not treated like other controlled drugs (morphine tablets being schedule 2). It will depend on the trust as to how they treat it.

Nurses typically work 12 hour shifts, 3 per week, even if one nurse short changed you (if) what happened during the remaining stay in hospital. I honestly think you are confused due to the pain

oramorph concentrate is 20mg/ml so that needs to be checked, what concentration was prescribed

@HappyHammy cups were 100% 10ml, the same used for formula top ups. Me and DH were invested in those being recorded correctly so can be positive of that.

I get that people have explanations but none that explain the sheer difference in what it was recorded I took orally and what I did.

This has been helpful anyway - I can see that if I make a complaint I won't be believed. I feel like I ought to report the discrepency but without the accusation, so if someone else is brave enough to report the evidence is there.

Community mental health and HV can't believe having spoken to me the day I got home that a MH referral was made - I was absolutely fine, said as much and displayed not an inkling to the contrary.

To those who say she wouldn't have been so obvious as to do it so blatantly - why not? As is evidenced here, I saw what i was given with my own eyes, have witnesses to my lucidity, 3 doses claimed to be administered that neither me nor DH recall - and still nobody believes me, my sanity is questioned, and she is free to act with impunity.