EBB 404 – Mini Q&A about Average Time Spent Pushing, Precipitous Labor, and Okra Water During the Third Trimester

Dr. Rebecca Dekker – 00:00:00:

Hi everyone. On today’s podcast, I’m going to do a mini Q&A about a new study on the average time spent pushing. We’re also going to talk about precipitous labor and are there any benefits from drinking okra water during pregnancy? Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. On today’s episode, we’re going to revisit a deep dive into a recently published article about the time spent pushing when you delay pushing during the pushing phase, as well as share some answers to questions our team answered this year inside the Ask the Research Team forum for Evidence Based Birth® Pro Members. So if you ever personally want to ask myself or one of the other researchers at Team EBB a question, you can do so inside the Evidence Based Birth® Pro Membership. And you can learn more about that at ebbirth.com/membership. We do have monthly, quarterly, and annual membership options available, as well as scholarship options. So if you’re interested in accessing the full range of resources at Evidence Based Birth®, I highly recommend getting involved with our Pro Membership, because not only do you get full access to our library of PDF handouts and continuing education courses and certificates, but you also get access to live monthly trainings, a doula mentorship program, a midwife brunch and learn program, and of course, direct access to ask our research team questions about the evidence.

Today, I’ve chosen one study to review with you all and two additional questions and answers to share here on the podcast. So these three questions have to do with number one, what is the average time spent pushing during the second stage of labor if you delay pushing until you feel a strong urge to push? Number two, what is the evidence on precipitous labor or labor that goes really quickly? And number three, what is the evidence on the health benefits of drinking okra water in the third trimester? So are you ready to hear the answers to these questions? Let’s get started. So for this first question, this came up this past winter when I was stuck at home during an ice storm that kind of shut our city down for about two weeks. During that time, I decided to use some of my new free time to answer a question that had been submitted to us over and over here at EBB. This question had to do with a new study that had been recently published showing that delaying the pushing phase can lead to active pushing times of 15 minutes or less. Yes, pushing for less than 15 minutes. So I published the review of this new study on Instagram, and it must have really hit a chord with a lot of people because the response was instantaneous. People really wanted to talk about the study. For the sake of everyone else who didn’t get a chance to listen to that video, I’m going to go ahead and share the audio from that Instagram reel here on this podcast. So here you go. Here is my review of the study about very short pushing times.

Hi everyone. So I’ve been getting a lot of questions about this study that was recently published by Montfort et al called active second stage duration under 15 minutes in spontaneous vaginal deliveries with delayed pushing. So some people are saying these are pretty wild results. How is it possible to have pushing in under 15 minutes? What does this mean? So if it’s okay with you, I will go ahead and kind of explain what the study found and a little bit about what it means for us. So this study was published by a team of doctors and researchers in France. And in the paper, they start off by reminding everyone that the guidelines for the pushing phase of labor differ in France versus the United States. In France, delayed pushing is the standard. That’s when you wait until the patient feels an urge to push and the fetal head is very low in the pelvis. And that is recommended in France. Now there have been several large randomized controlled trials comparing delayed pushing with immediate pushing, and they’ve had mixed findings, and there’s also some limitations to these studies. Which is why we don’t see a universal recommendation around the globe. Instead, every country is doing it a little bit differently. And even in the United States, where immediate pushing seems to be more encouraged. You might have some providers that do recommend delayed pushing. Now this particular study was a retrospective observational study, meaning they were looking back in time at medical records from a large hospital system. To look at the results of their delayed pushing protocol. The data for this study came from a single hospital in France and they only included women who were giving birth at term to a single baby in headfirst position. And they excluded anyone from the study if you gave birth by a Cesarean, or if you had a stillbirth, or if you had vacuum or forceps assisted deliveries.

Now, the standard care at this hospital in France was to provide care with midwives. So everybody had a midwife and everybody had delayed pushing after they reached complete dilation. So as long as there were no abnormalities, no fetal heart rate problems, no severe pain, no need for an urgent delivery. Then patients can wait. Up until three hours before they started pushing. And pushing was recommended to begin once there was a maternal urge and low fetal station. All of this information they track in the medical records in terms of when was the urge felt, when did they start pushing, et cetera. Other policies at this particular hospital include having forceps or vacuum assisted delivery if there’s no progress after 30 minutes of active pushing. Pitocin can be started. During the second stage of labor if, there have been two or more hours of dilation without the baby descending or without a maternal urge. The use of episiotomy is restricted in this hospital. And hands-on perineal support is used. All women at this hospital are offered epidurals. And the epidural, if chosen, can continue throughout the second stage of labor.

They defined the passive second stage of labor from full dilation to the onset of pushing, and the active second stage of labor is defined as the length of time that the patient was pushing. Until the baby was actually born. The researchers ended up with more than 10,500 participants in their study. About one third or 36% were giving birth for the first time. And 5% were having a VBAC. The average maternal age was 31, the average BMI or body mass index was 24. 82% of patients had an epidural and 18% of these labors were induced and 98% of the sample gave birth lying on their back. The average pushing length for the entire study was only about nine minutes of pushing. The median was six minutes and the range was from zero to 64 minutes. Epidurals were associated with longer pushing times, 9.3 minutes versus 6.6 minutes. And a longer passive phase of the second stage. One and a half hours versus 12 minutes. Overall outcomes at this hospital were very good. And in this particular study, Severe perineal tears only occurred in 0.5% of participants, and 95% of the participants had an estimated blood loss of less than 500, so very few cases of postpartum hemorrhage. Newborn outcomes were also good. 99% of babies had an APGOR score of greater than 7 at 3 minutes. So why do these outcomes look so good? One reason is because they only looked at the good outcomes. Remember, they excluded anyone with complications during the birth from this data set, including those who had longer labors or for other reasons needed a Cesarean, and they excluded those who needed a forceps or vacuum delivery, which is a big reason the outcomes look so nice. If you take out all the people with problems, you’re going to have problem-free data sets. Also, remember that most of the people in this study were giving birth for a subsequent time they’d already had a vaginal birth before, although the first-time moms in the study also had surprisingly low pushing times. Remember that midwives provided most of the labor in birth care, which could explain why The perineal outcomes are so good. However, it was surprising to me that 98% gave birth lying on their back. The passive descent phase took more than three hours and 30 minutes in some cases. Which could explain why the active pushing phases were so short. If the baby is almost all the way out by the time you start pushing, then you don’t have to push for very long. Another thing that’s helpful to know is that birthing patients are encouraged to push with great intensity in France. And the authors say that their practices are much different than English speaking countries. So this could also help explain the faster pushing times.

So my end conclusion, they had great results, but they were looking at a set of births that went very smoothly. And I’m not sure if these results could be generalized to a hospital, say in the United States or Canada. If you wanted to replicate these results, you would need a midwife-led care setting where midwives are providing most of the care. You need a culture that supports a long waiting phase or passive descent phase in the second stage of labor. You would need to have providers with a track record of having very low rates of severe perineal tears. And you need to have a culture of really high intensity pushing where they are greatly encouraging you to push with great force. Most importantly, remember that this study does not prove causation. It’s looking back in time at a very low risk group of people who all had smooth, non-complicated births. However, it does show though that when birth is progressing smoothly and without complications under the care of midwives, it is possible to have a very short pushing phase with good outcomes when you’ve had a longer descent or passive phase. But only in a specific cultural environment, which I already just talked about. So I hope you found this little study review helpful. Okay, hopefully you all enjoyed that review that I gave of that study.

Next up, I’m going to answer two questions that were recently submitted to us inside the Evidence Based Birth® Pro Membership. This next question I’m going to talk about was answered by Dr. Morgan Richardson-Kuyama. And for those of you who don’t know what precipitous labor is, precipitous labor can be defined as a birth that occurs within three hours or less of the onset of labor contractions. So here is the question we got. Hi, research team. I’m wondering if there’s any evidence to suggest that precipitous labor can run in a family. Specifically, is there any reason to believe that if a woman had precipitous labor with her births, that her daughters may then go on to have an increased chance of precipitous labor themselves? I know we have some evidence on other topics, such as big babies running in families. So I’m curious about this subject. So here is the information that Dr. Morgan Richardson Cayama shared with our member. She wrote, thanks for this interesting question. There doesn’t seem to be any link in the research between a family history of precipitous labor and the chances of having precipitous labor in the offspring. However, this could be due in part that this hasn’t been studied specifically as something that might increase your chances of having precipitous labor. Morgan said that she found two studies that lend support for some other possible risk factors, but neither of those research studies looked at the impact of family history. The first study on precipitous labor that we looked at was published in 2004, and they set out to identify risk factors for precipitous labor. So they were comparing patients with precipitous labor, which they defined as birth within three hours of the start of contractions, to those without precipitous labor. While they included more than 137,000 participants, only 99 of them had precipitous labor. So it’s not super common. The researchers found that the precipitous labor group had higher chances of placental abruption, fertility treatments, intrauterine growth restriction, induction with prostaglandin E2, low birth weight babies, and they were more likely to be giving birth for the first time.

A similar study was published by Suzuki et al. In 2014, and they compared characteristics of outcomes between patients with precipitous labor and those without, and they used the same definition of precipitous labor. This study included 11,239 births to single babies, so no twins or multiples, and 1,606 were defined as precipitous. Looked at a range of factors, including whether or not this was your first baby, maternal age, the gestational age of the baby, birth weight, high blood pressure disorders, problems with blood sugar during pregnancy, placental abruption, use of pitocin during the birth, APGAR scores of the baby, hemorrhage, and perineal and cervical tears. So what they ended up finding is that the precipitous labor group did have an association with being young. So teenagers were more likely to have a precipitous birth. There was also a relationship with preterm birth and precipitous birth and being diagnosed with high blood pressure disorders. The Cleveland Clinic also has an article where they provide a list of what they consider to be risk factors, precipitous labor, and they describe the two studies that we already cited. Their list does not include family history as a risk factor, but it does mention some factors that may be related to precipitous birth, such as having a smaller baby, having high blood pressure, being induced with prostaglandins, and having a past personal history of precipitous labor. And we did come across a few websites that anecdotally state that precipitous labor might run in families, but at this time, we don’t have any evidence to support it as a risk factor. Although again, it doesn’t appear to have been studied, so it’s still possible that it could run in families. So I’ll make sure to link in the show notes to the resources that we mentioned as we were going over this answer in case you want to dive into the research yourself.

And then our third and final question for today’s podcast was answered by EBB research team member, Dr. Sara Ailshire, just last month. And this question has to do with the benefits of okra water. Their question was, I’ve seen more influencers posting about drinking okra water during pregnancy. These are the only studies I see about it, and they don’t claim anything close to what’s circling on the internet and TikTok. I’m curious if I’m missing any research, and I haven’t seen any discussion in our archives. So Dr. Sara tackled this question in May of 2026. So when Dr. Sara answered this question, she wrote, you are correct that there’s a big discrepancy between what circulates on the internet about the benefits of okra water versus what the evidence says about the benefits of consuming okra, the plant, during pregnancy. So the studies our Pro Member cited to us in their question are pretty representative about the research that exists on okra. So okra is a vegetable and there has been research investigating its nutritional benefits or other applications for what people are using okra for. These two studies our Pro Member cited and we’ll make sure to link to these in the show notes. They’re from Ethiopia and they highlight how okra is a popular food for pregnant people in that region. And the articles talk about the nutritional benefits it has, especially for people who are not well nourished during pregnancy. Aside from this more specific regional research that took place in Ethiopia, researchers are also interested in the compounds and nutrients found in okra for their potential to be used in diabetes prevention, cardiovascular health, and other health uses. Aside from this more region-specific research, researchers are interested in compounds and nutrients found in okra for their potential to be used in diabetes prevention, cardiovascular health, and other health reasons. But to date, these are all just hypotheticals that researchers have flagged for future study.

Other researchers correctly note that the folk wisdom about the health benefits of okra that are common in places where it’s widely consumed, like Ethiopia, is worth investigating from the perspective of food science, nutrition, and pharmacology. But like you said, none of this research reflects what we are seeing circulated on social media about the claimed benefits of drinking okra water. For anyone else who is listening who might not be aware of these popular claims, so what’s happening is that on Reddit, Instagram, and TikTok, people are claiming that if you drink okra water, okra water, so okra has been soaking in the water and it kind of gets the slimy juice into the water, there are claims that drinking this water in the third trimester could help lubricate the vaginal canal, making labor and birth easier. Others are making claims that drinking okra water can help naturally lower blood sugar, which may prevent gestational diabetes, or that okra water is naturally extra hydrating for you during pregnancy. Some other non-pregnancy specific claims about okra water that are currently circulating on social media include claims that it has weight loss benefits, that it lowers your cholesterol, that it might prevent or treat other types of diabetes, that it treats constipation, or that it can have sexual health benefits. However, it’s important to note that okra water and its uses are not documented by any peer-reviewed research that we could find. There are a few internet articles on the topic, but most of the information when you do a search on this topic comes from what people are saying on social media.

So when people make okra water, the slime that the vegetable produces is the substance that people claim is causing the beneficial outcomes. And that’s what’s getting attention on social media. So okra does produce this substance called mucilage, which contains many of the beneficial nutritional compounds found in okra. So as the name suggests, it is mucus-like. And the claims that really caught Dr. Sara Ailshire’s attention when she was researching the subject are the claims in the videos and the posts that suggest that the mucus-like slime from okra will help you produce mucus that will lubricate the birth canal so that the baby slides right out. And that’s the claims that you often hear on social media. So this reminded Dr. Ailshire of something she learned about the doctrine of signatures. She learned this when she was getting her PhD in anthropology. So the doctrine of signatures is the widespread practice of associating the shape of a plant or a characteristic of the plant with its effect on human health. An example of this might be the belief that eating walnuts is good for your brain because walnuts kind of look like a brain. They’re shaped like a brain. And the doctrine of signatures is something we often see in both historic and contemporary health systems, homeopathy, ancient Greek medicine, and Ayurveda, to name a few. There’s a good article about the doctrine of signatures written by Bennett and published in 2007, and we’ll link to that. And Bennett suggests that it isn’t that people see something that’s shaped like a bodily organ, a human organ, and just assume that it helps that organ without any other evidence, but instead that the doctrine of signatures is just a useful way of remembering what plants have been identified as being beneficial and which body system they are believed to impact. Walnuts are, for the record, good for the brain. So it’s kind of like using a mnemonic or something like that. The doctrine of signatures can help you remember that it’s a brain-healthy food ingredient.

So in regions where okra is grown and commonly consumed, people are familiar with it as a healthy food. And it’s one that is commonly prepared for pregnant and lactating people. Okra was originally brought to the Americas by enslaved peoples who used okra both for food and medicine. Okra is nutritious, it’s vitamin rich, so it makes sense that it would be popular to give to pregnant and postpartum people. Similarly, drinking water and staying hydrated is always important for health and well-being, including and especially during the third trimester. So okra water might not guarantee that you give birth in two pushes, like some people say on social media, but its popularity probably comes from a long history of okra being an important cultural food for pregnant and postpartum people, and they were often encouraged to eat it in some cultures. As for okra water itself and drinking the water that’s been kind of infused with okra, as long as the okra was cleaned prior to being steeped in the water, and as long as that water was kept at a safe temperature and consumed shortly after being prepared, there are probably no risks to consuming okra water greater than what could be expected from consuming okra itself, which is considered a healthy plant. So thank you for that opportunity to answer that question and dive into the relationship between culture, history, food, and pregnancy. This was a really thought-provoking question, and I hope it helps those of you who are listening who sometimes see this topic brought up on social media.

So that wraps up our mini Q&A, all about fast-pushing phases, precipitous labor, and the belief that drinking okra water will make your labor go faster. Thank you for listening, and if you have a question about the research, remember that our research team is available to answer your questions inside the EBB Pro Membership, and we’ll put the link on how to join the Pro Membership inside the show notes. Thanks again, and I’ll see you next week. Bye.

Today’s podcast episode was brought to you by the online workshops for birth professionals taught by Evidence Based Birth® Instructors. We have an amazing group of EBB Instructors from around the world who can provide you with live, interactive, continuing education workshops that are fully online. We designed Savvy Birth Pro workshops to help birth professionals who are feeling stressed by the limitations of the healthcare system. Our instructors also teach the popular Comfort Measures for Birth Professionals and Labor and Delivery Nurses workshop. If you are a nurse or birth professional who wants instruction in massage, upright birthing positions, acupressure for pain relief, and more, you will love the Comfort Measures Workshop. Visit ebbirth.com/events to find a list of upcoming online workshops.