The fourth FANC visit should be the final one for women in the basic component and should occur between weeks 36-40 of gestation. You should cover all the activities already described for the third visit. In addition:
- The abdominal examination should confirm fetal lie and presentation, as you learned in Study Session 10 and 11 and in your practical training classes. At this visit, it is extremely important that you discover women with a baby in breech presentation or a transverse lie and refer her to the nearest health facility for obstetric evaluation.
- The individualised birth plan (Box 13.4) should be reviewed to check that it covers all aspects of birth preparedness, complication readiness and emergency planning, as described in the next section.
- Provide the woman with advice on signs of normal labour and pregnancy-related emergencies (described in Study Session 15) and how to deal with them, including where she should go for assistance.
What is meant by breech presentation, and what is a transverse lie? (You learned this in Study Session 11.)
Breech presentation is when the baby is 'head up' in the uterus near the end of gestation, with its buttocks, feet or legs pushing down into the mother's cervix. A transverse lie is when the baby is lying sideways across the abdomen.
A baby in the breech presentation may be delivered through the vagina in a health facility. A baby in the transverse lie can only be corrected into the normal 'head first' or vertex presentation by an obstetric specialist, or it must be delivered by caesarean surgery.
Box 13.4 Individualised birth plan
An individualised birth plan is a guide for healthcare providers developed in discussion with the individual woman and her partner or main support people which reflects their preferences about the planned birth. Some couples choose to have their baby at home under your care because they see birth as a normal part of life. Others choose to have a hospital or health centre birth. The birth plan for HIV positive women should be to deliver in a health facility, according to the National Guideline for PMTCT of HIV (as described in Study Session 16 of this Module).