# The Effect of Emotional Self‐Regulation Counseling on Anxiety and Fear of Childbirth in First‐Time Pregnant Women: A Clinical Trial Study

## TL;DR

A counseling program to improve emotional regulation significantly reduced anxiety and fear of childbirth in first-time pregnant women.

## Contribution

A midwife-led counseling program based on Gross's emotion regulation model was tested for reducing pregnancy-related anxiety and fear of childbirth.

## Key findings

- The counseling group had significantly lower pregnancy-related anxiety scores compared to routine care.
- Participants in the counseling program showed significantly reduced fear of childbirth.
- The effects remained significant after adjusting for insurance status.

## Abstract

Pregnancy‐related anxiety and fear of childbirth are common in primiparous women and contribute to high cesarean section rates. Few interventions specifically target emotion regulation skills.

To evaluate the efficacy of a brief, midwife‐led, group‐based counseling program grounded in Gross's emotion regulation model in reducing pregnancy‐related anxiety and fear of childbirth.

Pragmatic randomized controlled trial in Hamadan, Iran, 2023. Seventy primiparous women (28–33 weeks gestation) were allocated (1:1) to 6 weekly emotion regulation counseling sessions or routine prenatal care. Primary outcomes were post‐intervention scores on the Persian Pregnancy‐Related Anxiety Questionnaire (PRAQ) and Childbirth Attitudes Questionnaire (CAQ), analyzed by ANCOVA adjusting for baseline scores.

Adjusted mean PRAQ scores were 36.65 (SE 2.74) vs. 66.41 (SE 2.74) (adjusted difference –29.76, 95% CI −37.28 to −22.24, Cohen's d = 1.95, p < 0.001). Adjusted mean CAQ scores were 25.51 (SE 1.07) vs. 35.99 (SE 1.07) (adjusted difference −10.48, 95% CI −13.48 to –7.48, Cohen's d = 1.71, p < 0.001). Effects remained robust after adjustment for insurance status.

This brief emotion regulation intervention produced large reductions in pregnancy‐related anxiety and fear of childbirth. Findings are preliminary due to single‐center design, lack of blinding, and subjective outcomes. Larger multicenter trials with attention controls and long‐term follow‐up are needed before routine implementation.

Trial Registration: IRCT20230115054147N1.