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?

*now

your DH would not have been in recovery with you

This is not always accurate. It wasn't normal but my DH was allowed in - a preplanned thing which deviates from the norm, apparently, but special circumstances around risks to me during the op, he was permitted in to support: I won't share details of why as they're too specific, but this was at an NHS hospital earlier this year. I requested it and the obstetrics team were familiar enough with my case to grant without any questions. I didn't want to be alone incapacitated / unable to move.

Op, please report to the hospital or pals etc.

This might put an innocent midwife under inspection but I'd want to avoid similar happening to someone else. I couldn't imagine having the opportunity to spare someone preventable agonising pain, which I also experienced after my csection due to various factors, including an awful developing infection that later had to be cleaned out, do report in case your fears are founded.

Apart from anything you may want future DC and I wouldn't want this experience left as it is; your confusion can be investigated so it's a bit clearer what happened and why.

Also the whole DH wouldnt have been in recovery with you - does it depend on what 'recovery' is and the trust/hospital one is at? My husband wasnt allowed in theatre with me but he stayed with our baby in an assessment/recovery room while I had the op then after they brought me straight back to that room to be with him and our baby while I recovered. I then, after some time spent in recovery, went to the ward with baby and husband. I would colloquially refer to this as my husband having been with me in recovery. I dont know if technically it was 'recovery' or just an assessment room. All I know is that I was told we had to wait there for my recovery to be checked before moving to ward

You do need to make your concerns known, so that it can be investigated, a random drug test after the nurse comes off duty will confirm or expell any concerns you have, and if true will help other patients.

In answer to OP yes in my experience most patients accept that they are being given the right dose of medicine, counting mgs or mls of morphine would be concerning. It is completely plausible that the anaesthetist suggested a higher dose than what the obsteric SHO perscribed. The only way is to see the drug chart. I agree with the others you need a debrief.

I think must be history of mental health or heavy drug use

Haven’t RTFT but as a former midwife oramorph is a controlled drug in lots of places (including where I have worked) so there is an account of how much is dispensed, when, by whom & for whom, with 2 people checking. If you flagged your concerns over what was given and when, ask for a debrief and they can provide the documentation (if this hospital checks it in pairs) of the drug book.

Congrats on your baby, I’m sorry to hear you had such a rough and difficult start, certainly not how anyone should be treated.

In some trusts after the woman has come round from the GA, and she has been moved from theatre into recovery partners are allowed to stay with the woman, this is mainly so they can help look after the baby.

As others have said, there may well have been a maximum dose limit prescribed as well as the does and frequency. It is not uncommon for an "as required " prescription to say X-2X mg every Y hours with a maximum of Z mg in 24 hours, where Z is much, much smaller than what the maximum would be if 2X was given every Y hours. This gives the dispensing nursing staff some discretion to adjust dose and frequency for individual patient needs whilst providing a safety net to avoid too much being given.
So that may be at least part of the explanation of what happened here.
However, mistakes do happen. That is undeniable. I wouldn't leap straight to the conclusion that the MW was stealing the morphine, but procedural errors are made. Nurses are not supposed to sign for drugs until after they have been administered but it does sometimes happen. This happened to me this year in fact. I requested pain relief whilst in hospital only to be told that I had already had it. I absolutely knew I hadn't so refused to accept the situation. I was vindicated when it transpired that the drug that I had allegedly been given was not stocked in the department that I was in at the time. The nurses doing the drug round had signed for it as given, then gone to get it, not found any so obviously didn't give me anything but then got distracted or forgot for whatever reason and didn't tell anyone. When I rang for more pain relief the shift had changed and as far as they were concerned I had had it, as the drug chart was completed. Fortunately for me, the sister on duty realised what had happened or I could have faced similar accusations to the OP.
So whilst I wouldn't go in with all guns blazing accusing the staff of conspiring to steal opioids, I think the OP is reasonable to ask for a meeting to discuss the handling of her pain relief in general.

Op you said you were worried to use the pump in case you were accused of drug seeking. This was before the night that you think you didn't get the right amount and subsequently the hospital staff said there might be mental health issues etc.
Are there previous drug addiction issues at play here? Otherwise why would you be worried about 'drug seeking' before any issues were raised?

I agree you need to see the drug chart to know what was documented maybe a proper debrief to see if talking through what happened helped

For example
Medicine cups are 30 mls they always have been even in peads (or at least everywhere I have worked) I have never seen a 10ml cup even if you google I just can't see where they exist. So I think some of your memories must be confused the only way to sort through them is to talk it through with people who have access to the records.

That said all the medical reason for you not having adequate pain relief should have been explored before accusing you of things, other medications tried the pain team being called so something definitely went wrong here again a debrief might help you and then figure out what and make improvements.

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.

Yes, this! I was dosed up to the eyeballs on all kinds of drugs before and after both of my births. I couldn't tell you the names of the drugs or the doses if someone put a gun to my head.

The OP wasn't on it for 5 days! Is no one reading what she's saying? You only get it post op for 12-24 hours. The midwife on the night shift gave her three doses of 5ml (10mg) every 4 hours so 30mg total then recorded that she'd actually given the OP six doses of 10ml (20mg) every 2 hours so 120mg total. I think the OP would remember being given three extra doses of medicine and double the dose each time? She'd have barely been able to remember her own name being given 20mg every 2 hours. When I got a c section, I was given 5ml (10mg) every 2-3 hours. They offered to give me 10ml (20mg) every 4-6 hours if I wanted instead but I said the 5ml every 2-3 hours was fine. There's no way she was given 120mg of morphine in 12 hours and was able to hold the baby and have conversations with people.

I was pretty heady on 5ml every 2-3 hours. The dose is usually 5-10ml every 4-6 hours. If you're needing 10ml every 4-6 hours they will often offer you 5ml every 2-3 hours instead so a smaller dose more often which I had. I'd not have been able to hold my son getting 10ml in one go so I refused and wanted a smaller dose more often. I too was only given it for 12 hours post op. It's unusual to be given it for days after a c section.

@oldstripeyNEWname1
Totally agree, incredibly annoying thread. This is the most sensible reply by a long way.

OP has clearly had a traumatic birth and difficult recovery, she needs support not cheerleaders yelling “report, report, report”.

This ^

OP, why don't you request a copy of your medical records from the hospital. Then you can check the drug chart and see whether it accords with your recollection (i.e. that it records 20mg every 2 hours, although I think your recollection was actually 20ml every 2 hours and you now think that my have been wrong).

If it does say 20mg every 2 hours, you can decide what to do. It seems to me that the most sensible thing to do would be to write to the hospital in purely factual terms setting out your complaint, i.e. I was in a huge amount of pain overnight on X date; the midwife came to me three times and administered 5 ml of oramorph; when I asked for more pain relief in the morning I was told I'd already had the maximum dose and my chart shows that I was given 20 mg every 2 hours. My husband and I can confirm that this is not correct. I would like the hospital to investigate the mis-recording of the drug dose and the fact that I was left in significant pain throughout the night (and thereafter, if you want to explain the consequence). All factual, no accusations. But if there is an issue, it allows the hospital to pick it up.

But you really can't get anywhere without getting hold of your medical records (specifically that drug chart) to confirm your recollection.

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

Really? Well your nurse friend is a drama queen. Stealing drugs for self use isn’t very common. Yes, it can and does happen but your nurse friend is talking through her arse if she says it’s very common.

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!

Where and why was blood being squeezed in?

Oramorph is usually signed out by 2 members of staff.
And as somebody above stated if you were having 5mls at a time that’s 10mg each time.
Doctors do not prescribe in mls as there are different strengths if all drugs including oramorph.
Also to bear in mind that if you are opioid naive the first 48 hours of taking it can make you very confused so either consider that or be prepared for that to come up.
Also to bear in mind that morphine is good but is not as effective for everybody.
I am not saying you are wrong but there are probably easier ways to steal morphine if you are that way inclined.
Just some things to consider.
If after thinking everything through you really still think that happened then yes go through the right channels.

I’m sorry you’ve had a rough time op.

I think you should have a debrief or report your concerns. I think you have to be prepared for them to ask you difficult questions such as why you didn’t report the nurse appearing under the influence of drugs at the time etc? But surely you understand such questions need to be asked.

The accusation is above getting into trouble at work, it is a a criminal offence which she will be charged in a court of law if she’s found guilty. If you genuinely believe this midwife is stealing morphine whilst on shift, you must report it. This lady cares and delivers babies for a living, lives are at risk. Being worried you’ll be asked difficult questions Is not an excuse I’m afraid.

I'm curious about the blood being squeezed in as well ?

The level of pain you were in sounds awful and nothing like my experience post EMCS

I was given the advises doses of pain killers and was pretty much away with the fairies.

Someone could have stuck a fork in me and I wouldn’t have felt it.

I’m sorry for your experience

oldstripey summed it up perfectly

The op said she lost a lot of blood so I guess they were trying to get blood into her as quick as possible with the squeezing.

As an aside morphine is given sub cut for cancer patients and as pain relief for most long term condition as first line and is just as effective as IV/intramuscular with less pain from administration