There are cases of postpartum retention of urine reported every year in our health institution. All women who have delivered a baby either vaginally or abdominally are at risk of postnatal urinary retention, although risk factors have been identified it is difficult to predict. Postpartum urinary retention in contemporary obstetric and midwifery practice is rare but may be associated with long-term bladder dysfunction. Early diagnosis and intervention are necessary to prevent bladder damage. 

We have implemented a guideline for bladder care in the perinatal period. This guideline applies to all clinicians working within maternity services. It includes documenting the first void and urine output monitoring. It also includes a best practice algorithm for management of urinary retention and referral to community bladder and bowel nursing service (BABS). 

Auditable standards are in place to detect postpartum urinary retention through urine output monitoring and a referral pathway to the bladder and bowel nursing service for community trial without catheter, treatment, and monitoring. 
	
This audit explores the follow up delivered by the bladder and bowel nursing service (BABNS) and patient outcomes after discharge following post-partum urinary retention.

•	Monitor compliance with the bladder care guideline and referral process 
•	Evaluate the numbers of referrals to BABNs
•	To evaluate the nursing intervention and time spent 
•	To measure patient outcomes

Data collected Dec 2019 -Oct 2020
•	25 women referred via email to BABNs from midwifery
•	Ages 21yrs -41 (mean 30yrs) 
•	22 post-partum retention with catheters in situ
•	3 LUTS without catheter
•	17 fitted with catheter valves 
•	5 no valves, catheter on free drainage (2 bladder injury)
•	Contacted by telephone within 24-48 hrs to assess
•	Home visit 10-14 days (mean 5) to TWOC /teach intermittent self-catherization (ISC)
•	3 referred Urology /bladder injury /1 Urodynamics/ 1 Twoc’d on the ward

Nursing Interventions 
•	Catheter equipment prescribed on discharge 
•	22 Twoc’d 
•	16 (73%) taught ISC (1 failed ISC)
•	2 declined ISC
•	12 (75%) stopped ISC after 1 wk. (spontaneous voiding)
•	1 ISC for 49 days
•	22 offered telephone review for support/ or visits and 6 wk. PVR scan

Catheter valves were used to facilitate normal bladder filling and emptying, compliance with policy was high. Over half were taught and compliant with ISC. Teaching ISC and supporting women until normal bladder function returns is an important role for the BABNS which impacts on the Womens overall experiences of childbirth. Post-partum urinary retention is distressing and learning and living with ISC poses yet another unexpected anxiety at a time when anxiety levels are high. Normal voiding resolved at varying speeds. Managing these women is challenging due to the emotive circumstances and timing. BABNS interventions were significant and time consuming it calls for integrated f services and adequate nursing resource. Unfortunately, many UK continence services are under resourced.