Birth notes discrepancies

[TiredMama1234]

Hi there (apologies for long post but I have some things I’m unpacking!)

i wonder if anyone with a bit more knowledge of these things can help set my mind at rest. After a SAR for my notes, I noticed a few discrepancies, and one in particular that has concerned me the most. I referred it directly to the head midwife at my hospital but was ignored so I’ve now forwarded it to PALS and am awaiting a response, which I’m sure I’ll receive.

Essentially, it states in my notes that I was administered pethidine. It says this on a drugs administration form and also my birth summary documents but not detailed at all in case notes. My mother and husband were present throughout the birth and said they did not witness this drug being administered or discussions being had around it. I was not asked about this drug at any point. I had, and still have, very strong views about not having this drug (no issues with women who do have it, I just didn’t want to have it) so I know I would not have consented if it was offered. As far as I was aware, I had codydramol and oramorph, entonox and, eventually, an epidural. It was my understanding that these were completely separate drugs to pethidine but I may be wrong. I was after limited medical intervention but with the nature of things, had to have an induction via syntocinon drip and they suggested the epidural was the best way forward. It didn’t work, even though I had two attempts, but that’s another story.

My baby did not latch for 2 hours after birth (despite frequent attempts by me, I even have a video where I am asking people to help me and being completely ignored which is hard to look back on), we had feeding difficulties and subsequently had to be readmitted to hospital for weight loss on day 3 pp, so I am, naturally, now concerned that this was an after effect of this drug.

I may well be adding 2 and 2 together and getting 5 here but I am now pregnant with a second child and this is all playing out in my head again. I’ve not got much confidence in the care, though there were positives of course it is very difficult for me to focus on those, outside of being thankful for my healthy baby at the end of it. I probably do have some trauma over feeling disregarded that needs addressing too, which is secondary to this.

if the answer is simply “don’t worry, pethidine is something they write down for gas and air and it’s actually entonox” then cool, I’d love to hear it! Any kind of context would be helpful and thank you so much if you even got this far!

Are you getting the morphine and pethidine mixed up maybe?

Oramorph, Codydramol and pethidine are all opioid analgesic pain killers.

What medicines do your notes say you were given? TBH, if I’d taken any one of those, let alone all 3, I’d have been completely off my face!
I did have pethidine and have no recollection of about 6 hours of Labour after I was given it.

Also, despite being drugged up to the eyeballs first time round, and a 36 hour back to back Labour, second time round I had no pain relief at all, with a 2 hour Labour and a huge baby!

I did wonder about this but it says distinctly “pethidine” and “oramorph” separately? And I definitely consented to oramorph, I can see it in case notes and I remember it. No mention of pethidine in handwritten case notes so can’t work out where in the timeline it was given. They’re two separate things right? Maybe they’re not?

Yes actually it was a 40hour back to back labour for me so it’s good to hear your second didn’t follow suit! Thank you, that’s reassuring!
I was given codydramol right at the start, early stages. Oramorph came at various points whilst I was at home and then later on labour ward. From what I can see, my last oramorph was 4.30pm and I gave birth 6.30am the next day over 24hours later.
My birth plan specifically drew a line with pethidine just because I didn’t want to take anything that could pass to baby (rightly or wrongly, that was just my request) so as far as I was aware, I didn’t have this, which is why I found it odd to see it on my summary notes. I’ve attached a screen grab. I’m sure this is all down to me being a layman and just having no idea what I’m talking about!! It may seem like a funny thing to fixate on but I think I’ve struggled generally with being out of control and there’s a few instances throughout the birth and postnatal care where I didn’t feel listened to.

I had pethidine, it was an injection in my leg I think. It didn’t affect my baby’s latch at all though. I also had a difficult birth, I.e. 3 days in labour, constant vomiting, forceps, eventual emcs.

I can completely understand your anxiety due to the quality of the after care. The way they treat women after they give birth is appalling. I had temporary kidney failure after the birth due to extreme dehydration, I just had my fluid drip removed, I asked for water as I was extremely thirsty and the midwives refused to get it for me, telling me that walking about would help me heal (dp had gone home for a few hours to rest and my mum was on her way). I was extremely distressed as I couldn’t walk to get water or get out of bed by myself to reach my own baby. The doctor who came to check me over had to help me. It still upsets me today.

I would definitely get this checked out. It’s imperative that they record what drugs you’re given correctly!

Also, isn’t pethidine an injection? Part of me wonders if this is just poor note taking? Which still concerns me.

Sorry I’ve just seen this when I posted my last reply - I’m so sorry this happened to you! That sounds absolutely horrific.
as I understand it, pethidine wouldn’t pass to baby if done early enough before birth, but because the timeline doesn’t state when it was administered to me I can’t tell if that was the case or not.

How did you have access to oramorph at home?

Sorry I’ve not explained properly. It was only ever administered in hospital but I was sent home after the first lot to get some rest, then had more back on labour ward.

Pethedine is give as an injection into the leg. It could just be a simple error and they thought it had been given. If given at the height of a contraction or at a difficult time, you may not have noticed it. Maybe a HCP stole it and said it was administered (quite unlikely!). Either way it wouldn't have affected latch or anything. It would have been out of your system and as you had other significant pain relief, I wouldn't fixate on this. No one is going to remember this far on in the proceedings if an error was made, and it's not serious enough (as in no adverse outcome) to investigate. Let it go. Concentrate on your birth plan

Just ask for a birth debrief. This is why medical notes are ideally reviewed with someone who can explain them.

Some trusts have online self referral for this (E.g. www.dgt.nhs.uk/services/a-z-services/maternity-services/online-self-referral-form-birth-experience-debrief). Google the trust you gave birth at and birth debrief, you should find the process.

I think PALS is the right place for this query. It seems one of three things has happened 1) you were given pethidine without consent, 2) it was given to another patient but documented in your notes by
mistake, or 3) a clinician is stealing pethidine by documenting on the drugs chart of labouring women, most of whom would never look at their notes afterwards.
All of the above are serious concerns and therefore helpful for you to raise.

I hope you find the closure you need on this, best of luck with your current pregnancy.

Thank you everyone. I do feel that a debrief would be useful. I do need to move on and let it go, I guess I’ve found it difficult processing what was a very traumatic birth and postnatal care for both myself and baby. I’ve requested a home birth for this second time round in the hope I might be able to wrestle back some control and some of what I wanted my first birth to be like!!

Could it be that Pethidine was written up on the drugs chart in case you wanted it at some point, but was not given? A lot of doctors will write up (prescribe) drugs in case they are requested by the patient later, but this does not mean they have to or were given. Hence why there is a documented note about receiving oramorph, because it was prescribed AND given.
As other PP's have mentioned, it's an intramuscular injection, usually given with an antisickness drug at the same time.
I'm so sorry you did not have a good experience last time.

This is interesting, I didn’t know this. There is a prescription form which says I had intramuscular injection of pethidine and an antiemetic before giving birth. So it was certainly dispensed. But absolutely no knowledge of it being administered to me, or any mention of it in my case notes, so it is a weird one, for sure.

So I wonder if it has been dispensed, but not given to me (as no date or time stamp to say it has) but then whoever has written up my notes has said it was given to me in error?
thank you everyone, this has actually been really helpful.