The Miles Circuit
Baby positioning tool for families + perinatal professionals
Introducing the Miles Circuit, an excellent tool to help get a baby lined up correctly, in the Left Occiput Anterior (LOA) position, both before labor begins and when some corrections need to be done during labor.
I named this circuit after my friend, Megan Miles, a doula and student midwife, who first shared it with me, as I brainstormed ideas to help a client have a successful VBAC. It has worked so many times both pre-labor and during labor that I now teach it in doula trainings, childbirth classes and share with my clients!
When to Use the Miles Circuit:
Prenatally, this position set can help to rotate a baby. As a natural method of "induction," this can help get things going if baby just needed a gentle nudge or position change to set things off. In labor, I often suggest this set of positions when labor seems to not be progressing, (i.e., contractions are not getting longer, stronger, and closer together), when the pregnant person has back labor, or the position is determined to be not LOA, either by vaginal exam or external palpation, or ultrasound. To the best of my knowledge, this group of positions will not cause a baby that is already lined up correctly to become malpositioned.
How to Use the Miles Circuit:
Remember, babies are constantly moving around during pregnancy and labor and may be very suggestible to some gentle nudges using this circuit.
The entire circuit should take 90 minutes from start to finish, and if contractions are present, be done right through the contractions. Before starting, the pregnant or laboring person should empty their bladder and have a nice drink in a sports bottle nearby for hydration. Follow along on this three step circuit:
Step 1: Open Knee Chest Position
Spend 30 minutes in open knee chest position. Start in cat/cow, then drop your chest as low as you can to the bed or floor and your bottom as high as you can. Knees should be fairly wide apart, and the angle between the torso/thighs should be wider than 90 degrees. Wiggle around, prop with lots of pillows, and use the time to get totally relaxed. This position allows the baby to scoot out of the pelvis a bit and gives them room to rotate, shift head position, etc.
If the pregnant person finds it helpful, careful positioning with a rebozo (buy a rebozo) or sheet under their belly, with gentle tension from a support person behind can help them to maintain this position for the full 30 minutes. I think this is key to being able to maintain this position for the entire time.
Step 2: Exaggerated Side-Lying Rollover
Roll to one side (whichever feels better), bringing the top leg as high as possible and keeping the bottom leg straight. Roll forward as much as possible, again using lots of pillows. Place a pillow under your belly, one or two under your head, one behind you and several under your top leg. Your bottom shoulder should be behind your top shoulder. Sink into the bed and relax some more. If you fall asleep, great, but if not, stay here for at least another half an hour. Try and get your top leg up towards your head and get as rolled over onto your belly as possible. A peanut ball helps!
Step 3: Get Up, Get Active & Asymetrical
Lunge, walk stairs facing sideways, two at a time, (have a spotter stand downstairs of you!), take a walk outside with one foot on the curb and one on the street, sit on a birth ball and hula- anything that's upright and putting your pelvis in open, asymmetrical positions. Spend at least 30 minutes doing this one as well to give your baby a chance to move down with gravity. If you are lunging or stair or curb walking, you should lunge/walk/go up stairs in the direction that feels better to you.
The key with the lunge is that the toe of the higher leg and the pregnant person’s belly button should be at right angles. Do not lunge facing over your knee, that closes the pelvis. Also, use a stepstool or other object that allows your thigh to slope gently downward. It should not be too high! Keep your knee parallel to your hip, during these movement, no higher!
Cat-Cow Position
Cat-Cow Position
Open-Knee Chest Position
Pro Tip: Use some pillows under the knees/chest & make sure the knees are behind the hips.
Side-Lying Position
Lunge with Stool
