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?

It is quite possible that the drug chart did say x dose ever 2-3 hours. Some people do prescribe like that, with a maximum dose per 24 hour period also specified. I certainly prescribe like that sometimes.

While the SmPC (product information) may state a maximum dose of 120mg/24 hours, prescribers in Britain usually don’t refer to the SmPC when prescribing. They use the BNF instead, which doesn’t state a maximum dose.

bnf.nice.org.uk/drug/morphine.html#indicationsAndDoses

Prescribers do prescribe outside of the SmPC (i.e. the drug’s licence). Just google “off label use”.

The dose they prescribed would have been based on how much morphine was needed to control OPs pain using the morphine pump in the previous 24 hours. If that equates to over 120mg oramorph, then it is quite possible OP was prescribed exactly what she says she was.

I would complain OP. Leaving aside whether your morphine was being stolen or not, it’s unacceptable to leave someone in agony overnight. If you were in that much pain they should have asked one of the doctors to review you as the pain could have been a sign of another complication. That they didn’t do that is worrying.

That they referred you to psychiatry and threatened you with SS involvement is even more bizarre. I’m so sorry you went through that.

Don’t expect your complaint to bear fruit, but it’s better to have your side on record in case the same happens to you or someone else in the future.

@Morphinemidwife when morphine is injected it is usually intramuscular or intravenously.

@tennis82 Sub cut is the fastest acting method, my veins were all bruised to fuck from them having spent the last few hours frantically trying to get blood into me. I woke up having not had IV morphine in theatre though I'd had the injections to my abdomen of something else. They seemed to be nervous that having finally revived me I'd go into shock from the pain as I was shaking vigorously.

Surprised its deemed suspicious to take an interest in how much medication you're taking - surely people don't just blindly consume potent substances??

Hopefully a debrief with someone who wasn't involved in your care would help you to clarify. I'm pretty sure I was given 5mls a time after my section. Whatever happened, I'm sorry to hear that your pain was poorly managed.

I had a not entirely dissimilar experience after my section when it comes to talk of drug-seeking. I had been prescribed a certain dose every few hours and was advised by a midwife not to take it unless I 'really needed it' in case the doctors thought I was drug seeking. I wasn't asking for an increased dose, just the amount prescribed to me. So when she came to administer pain relief, she gave me paracetamol and I felt too paranoid to ask her for my dose of oramorph even though I was in considerable pain. I decided to take every other dose so that no one thought I was an addict, which is a frightening thought when you've just given birth.

When the doctor came to see me he asked how the pain was and I said it was pretty bad but I was doing my best to take as little oramorph as possible because the midwife had told me that taking every dose would flag up. He said that was ridiculous and that they had prescribed me the correct amount of pain relief for the operation I had, and that it was important to have enough pain relief to get mobile. I had PTSD after a traumatic labour and didn't feel I could face making a complaint, but I probably should have in hindsight.

(They used ultrasound to find a vein for the pump and it took a long time).

Wasn't expecting to take oramorph for 5 days, just for the first 24hours or so when the remnants of the spinal would be providing the majority of pain relief otherwise.

Pinpoint pupils definitely ARE a morphine (and other opiates) thing to the couple of people who seem unsure.

I can't believe you were able to pay so much attention to your doses - having the wherewithal and determination to do so. After I'd had my C-section I couldn't tell you what my name was 😂

If only that were true, many many nurses and midwives are reported for things they are innocent of. Unfortunately the NMC have more of an guilty unless proved innocent stance. So yes they may not lose their career/registration over it but she will he put through hell in the process.

Sorry my message was meant to be in reply to @icannotremember

@shreddednips yep I can relate to that! The Dr made the comment about needing to stay topped up as when on the pump I was nervous to press it whenever I needed to for fear of being seen to "drug seek" after similar comments. So I was going hours, until the pain got unbearable, then was desperately pressing to fix it! He explained the total dose on the pump was really small, but works because you stay "topped up". His preference was for patients with acute pain to use the pump, but the ward had no staff to meet the monitoring requirements long term

Unless you ask to see your notes and see what was recored then you simply don't know. People make mistakes.

You feel a mistake was made. By a number of people. You think a midwife is stealing drugs from patients. You surely have a duty to report your concerns. To look at your own medical records and request that any discrepancies in recording be investigated.

Although I have a feeling you were never interested in actually doing anything about it. You were never interested in getting the hospital, the actual people responsible for your care, to look into your claim. Instead preferring to shrug your shoulders and say well Internet strangers think x, y and z, so that's that then.

Pointless thread really.

As if.

No, you're very confused here Op. first of all, your DH would not have been in recovery with you, it's not allowed, so he would have no idea what you were given then. The effects of morphine causes all sorts of confusion and lack of clarity. There is absolutely no way you would be at all aware of who gave you what.
Contact your GP and ask for a long appointment to go through your notes. They will have to request them from the hospital so this might take some time. I did this after a very traumatic birth and lots of my questions were answered to help me come to terms with it.

Morphinemidwife

Over what period of time did all this happen?

How long were you on the pump for? How long after the pump was removed did you get 1st dose of oramorph?

This all sounds very confused.

It all sounds very confusing and I’m not entirely sure about all the circumstances.
Subcutaneous is not the fastest route of medicine administration certainly, and I’ve never known morphine be administered in this way. Are you sure it wasn't intramuscular?

If anything it’s more likely to be a drug prescription error, in that it’s been prescribed wrong and that she has signed the prescription form wrong. I’m not saying this is ok, it certainly isn’t, and I don’t agree with the way the staff treated you regarding drug abuse and SS threats. However, I find it highly highly unlikely she was stealing your medication.

I think a debrief of your notes is a good idea, especially to help bring to light if there was a drug error, and the way you were treated. But please don’t just jump to a complaint of midwife drug abuse before going through the notes with a fine toothed comb. She could be entirely innocent and an allegation like that could ruin her.

Sub cut is the fastest acting method, my veins were all bruised to fuck from them having spent the last few hours frantically trying to get blood into me. I woke up having not had IV morphine in theatre though I'd had the injections to my abdomen of something else. They seemed to be nervous that having finally revived me I'd go into shock from the pain as I was shaking vigorously.

Having just come round from a GA, at risk of going into shock you most definitely still would have had IV access in situ.

DH definitely in recovery with me. He saw me having blood squeezed in and was in a far worse state than I ever was as a result!

@TellMeWhoTheVilliansAre I pointed out the discrepancy as soon as I saw what had been recorded on the chart but wasn't believed. It didn't occur to me she might have been taken it until recently.

I don't want the stress with a newborn of further SS threats or MH referrals and being gaslit about very clear memories and observations.
However, if my suspicions are correct, some other woman may lie in agony tonight in the same circumstances and not be so observant. Even if she hasnt been stealing it, a mistake was made that resulted in substandard pain relief. I was willing to overlook a mistake and forget about it. The realisation it may have been intentional means if I'm correct, it will almost certainly happen again. I cant have that on my conscience. I'm incredibly torn.

Obviously I can't comment on this particular situation but to those saying you wouldnt possibly be given more than 5ml/10mg etc, I have just had my baby and had to have an op after birth. I had a spinal injection for the op and then I was 100% being given 10ml of oramorph in hospital though I wasnt allowed it every 2 hours, it was every 4 hours approximately. I stayed in 2 nights as my pain was so bad I didn't want to leave without proper pain relief. Initially they weren't going to give me oramorph to take home but I was subsequently given a prescription for 10ml every 2 hours and a full bottle of 100ml.

I know I was having 10ml in hospital as it was administered in a syringe with the volume on the side and I could read this. My husband was with me and also confirms this. I wasn't off my face as some other people report though I did suffer the side effect of feeling itchy.

When I left I was surprised I had a prescription for 10ml every 2 hours. This is definitely the prescription, not 10mg, as I still have the box with the prescription on it given to me by the hospital pharmacy. I didnt take that much though as I didnt like the side effect of the itchiness which made me feel like an addict and wanted to wean off asap. I instead took 5ml doses 2 times a day which I subsequently changed after a chat with my midwife to 4 doses of 2.5ml a day spread out more but equalling 10ml a day. I then reduced this further to having just 2 doses of 2.5ml then one before nothing over a period of 1 week to 1.5 weeks.

I have never had oramorph before and they were content to give me the above dosages. One of my friends has chronic pain and is only on 2.5ml doses so I was keen to reduce asap to be honest as 10ml felt like a lot although when I initially had surgery in hospital it did make the difference in my recovery to be honest.

@Morphinemidwife surely if she was stealing the medication then when she went off shift in the morning the next midwife would have administered proper dose at appropriate time? Surely that should have made it apparent if there was something amiss the night before?

I’m confused also how you didn’t have IV access when coming round from GA??

After a bladder cancer resection and then daily radiotherapy for 6.5 weeks, I was in agony down below and at home on my own had to give myself 2.5 mls of oramorph every 4 hours. The only time I did this it had no effect at all on my pain but during the night I had sleep walking episodes, got out of bed the wrong side, in the dark, totally disorientated kept knocking into things and fell down, banged my head on the open door and was not sure if I had dreamt it or not.
After 4 months the pains have gone but I never bothered with the morphine again. 2.5 mls is very little but had a devastating effect on my brain taken every 4 hours.

Where I work it isn’t a controlled drug, (used to be classed as one) and if your midwife was giving it on her own it wasn’t a controlled drug at your hospital. So she wouldn’t need to steal yours, she could swig half a bottle in the sluice and nobody would notice!

We don’t give it routinely where I work, only paracetamol and codine. Agree with others that 5mls is the standard dose (10mg).

OP - do you have any previous mental health issues on your medical records?

This thread is really annoying.

Summary, in my view. Don't correct me because that's kind of the point I'm making. Arguing over details is missing the massive elephant in the room. TAKE ADVICE AND TALK TO THE HOSPITAL ABOUT THE WHOLE BIRTH EXPERIENCE

Summary
Op has very complex 6 hour CS under GA. Baby is well. Mum has massive blood loss, internal damage. Mum is, understandably, tired, shocked, dazed.

Dad is probaby tired, emotionally wrung out at potentially losing parter and child.

Mum and baby in side room for 5 days. Having morphine previously via pump, later ORALLY.

OP contests dose given on night 1, and care given on night 1.

Op complained about lack of pain relief on day 2. Says she was treated as if her pain was not real. Treated as if she had a mental health problem. Talks of addiction, and ss being threated.

Chart markings from night 1 of 5 only contested.

OP thinks nurse from night 1 took morphine.

Op realises this now, 6 weeks later, and wants to make complaint.

Parts of MN jury want to throw hcp to wolves, - half our midwives are addicted to crack apparently.

Parts of MN think OP has dose wrong and is confused.

Many sensible posts advising OP to review the entirety of her birth experience are being overlooked.

Op, heard the expression 'we see things as we are, not as they are?' It means you view all new experiences through previous experience.

So, I now know dh is allergic to morphine. I've seen him climbing up to ceiling in hospital, to get away from box of cereal that was going to arrest him (don't ask). Next day, no recollection and ADAMANT he'd been in agony, calling for pain relief. I've had 1 Cs and 2vbacs, with pain relief totally inconsistent application (that'll be the Redhead thing).

So, I don't know... Maybe, having just had major surgery, GA, pregnancy, morphine affected you differently. I'm not saying you aren't honest, or you didn't remember, or weren't in that much pain to be able to look at nurses pinpoint eyes or whatever has been suggested. Your partner? Tired, scared, freaked out at being impotent at being able to do nothing at the whole situation? I'm saying there are multiple explanations, and the best way to explore them, is to enter an open dialogue with the hospital, with all of your notes, and all of your questions. No presumptions. No accusations.

Secondly, about the mental health stuff. Again, viewing things as we are, not as they are. Do you know about the risk of post partum illness? I'm not talking about baby blues, or even post natal depression, but severe, acute, psychotic illness in the very early days. It is rare but is more common with the type of traumatic delivery you had. So to the posters having a go, saying it was typical for drs to dismiss you with MH needs, really, piss off. Because in this instance, well done them for looking out for signs of mental distress. Don't dismiss the drs as being difficult with you, because this is a really serious issue they would have to act on quickly (hours) and odd behaviour (similar to how you were on day1) could be a symptom).

Starting with the question 'what outcome do I need from this action?' might help you decide where you go next. An accusation against one person brings no resolution to you really.

Op why do you think j your dh was in recovery with you? Tbh you don’t seem very well even know. Have you been referred to the perinatal mental health team?