Counseling by Acceptance and Commitment Therapy Approach on Fear of Childbirth: A Randomized Clinical Trial

Katayon Vakilian1, *, Fatemeh Rahmati1, Mahboobeh Khorsandi2, Abed Majidi3
1 Department of Midwifery, Medical School, Arak University of Medical Sciences, Arak, Iran
2 Department of Health Education, Health School, Arak University of Medical Sciences, Arak, Iran
3 Department of Consoling, Isfahan University, Isfahan, Iran

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Creative Commons License
© 2023 Vakilian et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Midwifery, Medical School, Arak University of Medical Sciences, Arak, Iran; Tel:098-86-34173507; E-mail:



Fear of childbirth (FOC) is a common problem during pregnancy, that causes anxiety during pregnancy and severe labor pain.

Aims and Objectives

This study wants to investigate the effects of counseling during pregnancy in order to reduce the fear of childbirth (FOC). This clinical trial investigated the efficacy of acceptance and commitment therapy (ACT) on the fear of natural childbirth.


This randomized clinical trial was conducted on 66 consenting nulliparous women. After obtaining written informed consent from each participant, those who met the inclusion criteria were eligible to enter the study. Eight 45-60 minute sessions of ACT were held for the experimental group during prenatal care. The control group received just routine prenatal care. All subjects completed the Harman’s questionnaire at baseline, immediately after, and 4 weeks after intervention. The data were analyzed using a t-test, repeated measurement ANOVA, and Chi-square tests.


The results of the main outcome showed that the score of fear in the intervention group, from 41.47 decreased to 31.81 (p-value=0.001) immediately and 30.34 scores (p value = 0.001) 4 weeks after intervention. In control group, fear from baseline(37.79±6.85) changed to 38.45±7.01 and 38.52±7.15 in immediately and 4 weeks later (p=0.05).


ACT is an effective method of reducing the fear of childbirth in nulliparous women. We recommend this method can be added to the contents of prenatal training classes.

Clinical Trial Registration No.

The registration cod is: IRCT20190910044736N2

Keywords: Childbirth fear, Prenatal care, Reproductive health, Education, Cesarean section, Anxiety.