The Miles Circuit — Positioning for Optimal Fetal Alignment — Evidence Library

What it is

The Miles Circuit is a set of three positions — open-knee chest, exaggerated Sim's (side-lying with the top leg forward and supported), and an active upright/asymmetric position (walking, stair-climbing sideways, or lunges) — held about 30 minutes each. It was developed by midwife Megan Miles as a practical tool for stalled labor, posterior or asynclitic babies, and prodromal labor. The goal is to shift the relationship between baby and pelvis by using gravity, ligament release, and pelvic asymmetry, rather than to force a position change. Many people use it in late pregnancy for a suspected posterior baby, or in early labor when contractions have stalled and baby seems 'stuck' high.

Evidence review links

Each link opens the full review on the publisher's site in a new tab.

Possible benefits

Non-invasive, free, and doesn't require a provider or equipment beyond pillowsReview sources ↓
Can be started at home in late pregnancy or early labor without needing to go inReview sources ↓
Anecdotally helpful for posterior (OP), asynclitic, or high, unengaged babies and for stalled early laborReview sources ↓
Complements other Spinning Babies®-style positioning work (rebozo, side-lying release, forward-leaning inversion)Review sources ↓

Possible risks

Formal research evidence is limited — most support is clinical experience and case reports, not randomized trialsReview sources ↓
Open-knee chest and inversions are generally not recommended for people with high blood pressure, severe reflux, certain placental issues (e.g., placenta previa), or a history of retinal detachment — check with your provider firstReview sources ↓
Skip or modify if positions cause pain, dizziness, shortness of breath, or if you have SPD/pelvic girdle pain that's aggravated by asymmetric lungesReview sources ↓
Not a substitute for evaluation if labor is truly stalled, if there are decelerations, or if something feels wrongReview sources ↓

Alternatives

Spinning Babies® daily essentials (forward-leaning inversion, side-lying release, standing sacral release)Review sources ↓
Rebozo sifting and pelvic rocking with a partner or doulaReview sources ↓
Curb walking, side-stepping stairs, or asymmetric lunges aloneReview sources ↓
Position changes every 20–30 minutes during labor with support from your teamReview sources ↓
Chiropractic care (Webster technique) in pregnancy for pelvic alignmentReview sources ↓

Current evidence

The Miles Circuit is a clinical tool developed within the midwifery and doula community; it doesn't have randomized-trial evidence and isn't in ACOG guidelines. The broader principle it draws on — that maternal positioning and pelvic mobility can influence fetal position and labor progress — is supported by Cochrane reviews on maternal positions in first-stage labor, ACOG Committee Opinion 766 on approaches to limit intervention, and Evidence Based Birth's positioning review. Use it as one option in a toolkit alongside other movement and positioning strategies, not as a guaranteed fix.

Where the evidence is clear · where people may choose differently

For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.

Educational only. Your care team can help you weigh what applies to your specific situation.