The Miles Circuit
“Do The Circuit!”
This circuit is useful to help get the 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!
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 of position 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) mom has back labor, or the position is determined to be not LOA, either by vaginal exam or external palation. To the best of my knowledge, this group of positions will not “hurt” a baby that is already lined up correctly.
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, mom should empty her 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
30 minutes in open knee chest- 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 mom finds it helpful, careful positioning with a rebozo under her belly, with gentle tension from a support person behind can help her to maintain this position for the full 30 minutes.
Similar to the image here, but the knees should be further back so the angle between the belly and the thighs is more open!
Step 2: Exaggerated SIMS
Roll to your left side, bringing your top leg as high as possible and your bottom leg straight. Roll forward as much as possible, again using lots of pillows. 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 right leg, up towards your head and get as rolled over onto your belly as possible.
Step 3: Get Up and Get Active
Lunge, walk stairs facing sideways, 2 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 a 30 minutes doing this one as well to give your baby a chance to move down. 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 mom’s belly button should be at right angles. Do not lunge 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! (lunge illustration credit www.penmysimkin.com)
Please contact me if you have any questions or suggestions or would like to share your experiences with this circuit.