The Miles Circuit is a series of non-medical movements and resting positions created by doula Megan Miles to encourage a developing baby to move into an optimal position for birth. The primary goal is to facilitate fetal rotation toward the occiput anterior position, where the back of the baby’s head faces the front of the birthing person’s body. By utilizing specific postures, the circuit aims to create space and balance within the pelvis, potentially aiding in a smoother and more efficient labor process.
The Theory Behind Fetal Positioning
The effectiveness of the Miles Circuit rests on the anatomical principle that the baby’s position is influenced by the surrounding maternal structures. The pelvis is not a fixed, rigid structure; it is made up of joints, ligaments, and muscles that can be manipulated through intentional movement. When a baby is in a less favorable position, such as posterior or transverse, it can lead to longer, more uncomfortable labors and significant back pain.
The circuit’s positions are designed to relieve tension and lengthen specific muscles and ligaments supporting the uterus and pelvis. Creating this relaxation and balance helps to “unwind” the lower uterine segment, giving the baby room to rotate. Gravity is a significant factor, encouraging the baby to temporarily lift out of the pelvis and then settle back in with their head facing the anterior side, ideally the Left Occiput Anterior (LOA) position. This repositioning allows the baby’s smallest head diameter to engage and descend more easily into the birth canal.
Performing the Circuit Steps
The complete Miles Circuit is a ninety-minute sequence divided into three distinct, thirty-minute steps. Before beginning, empty the bladder and have pillows and water ready for comfort.
Open-Knee Chest Position
The first step involves the Open-Knee Chest position. The birthing person starts on hands and knees before lowering the chest to the floor or bed while keeping the bottom elevated. This inverted position is held for the full thirty minutes, using gravity to momentarily take pressure off the cervix and allow the baby to float up and potentially turn.
Exaggerated Side-Lying
The second step is thirty minutes of Exaggerated Side-Lying, best performed in a bed with ample pillow support. The person lies on their side, often the left, with the bottom leg straight and the top leg propped up as high as possible with pillows. This posture is designed to open and balance the pelvic outlet by lengthening the soft tissues on one side of the pelvis. Roll slightly forward onto the belly, ensuring the top leg is elevated near the head to encourage the baby’s descent and rotation.
Upright and Asymmetrical Movement
The final thirty minutes involves Upright and Asymmetrical Movement, utilizing gravity and pelvic motion to help the baby settle into the newly created space. Effective movements include walking sideways up stairs, taking two steps at a time, or walking with one foot on a curb and the other on the street. Alternatively, lunges can achieve the same asymmetrical effect; the toes of the raised leg and the belly button should form a right angle to open the pelvis. These active movements encourage the baby to descend deeper into the pelvis and lock in the optimal position.
Assessing Reported Effectiveness
The effectiveness of the Miles Circuit often depends on whether one is looking at anecdotal reports or formal scientific study. Many doulas and midwives report positive outcomes, citing instances where a stalled labor resumed or a baby in a posterior position rotated after the circuit’s completion. This practical experience suggests the movements can be a powerful tool for encouraging positional change, especially when labor has slowed or back labor is present.
From a medical perspective, there is a recognized lack of large-scale, randomized controlled studies specifically investigating the circuit’s efficacy. The circuit is a relatively new, holistic approach, and robust clinical trials have not yet been conducted to definitively prove its success rate. Despite the absence of formal empirical evidence, the underlying principles of pelvic balancing and the use of gravity are well-established concepts in obstetric physical therapy and fetal positioning techniques. The general consensus within the birth community is that while the circuit may not cause labor, it can help resolve a positional barrier, allowing the body to progress naturally.
Important Safety Guidelines
Before attempting the Miles Circuit, consult with a healthcare provider, such as an obstetrician or midwife, to ensure the positions are safe for the specific pregnancy. The circuit is recommended to begin around 37 weeks of gestation, when the body and baby are nearing readiness for birth. Listen closely to the body; the activity should be stopped immediately if any sharp pain, dizziness, or unusual symptoms occur.
Certain medical conditions, such as high blood pressure or placenta previa, may make some inverted or prolonged positions unsafe. When performing asymmetrical movements like lunges, care must be taken to avoid lunging over the knee, as this can inadvertently close the pelvic outlet rather than opening it. Maintaining comfort and safety throughout the ninety-minute routine is essential while attempting to create space for the baby’s movement.