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

ABSTRACT Background 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. Objective 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. Methods 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. Results 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. Conclusion 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.