Effect of Individual Counseling Program by a Midwife on Anxiety during Pregnancy in Nulliparous Women

Document Type : Original Article


1 M.Sc. Student of Consultation in Midwifery, Student Research Committee, school of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Assistant Professor, Department of Midwifery, Research Center for Evidence-based Health Care, school of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Associate Professor, Department of Educational Sciences, Faculty of Psychology and Educational Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.

4 Professor, Department of Biostatistics, Research Center for Health Sciences, Faculty of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Anxiety is a common problem among pregnant women, which has a negative impact on mother and neonate. Midwives are responsible for providing advice and giving care to mothers during pregnancy, delivery, and postpartum. This study was conducted to evaluate the effect of individual counseling program by a midwife on anxiety during pregnancy in nulliparous women.
Materials and Methods: This clinical trial was conducted among 90 primiparous women with the gestational ages of 28 to 30 weeks referred to healthcare centers of Mashhad, Iran, during 2015-2016. The participants were randomly assigned into two groups of intervention and control (45 individuals per group). The subjects in the intervention group received three sessions (once every two weeks) of the individual counseling program based on the content of the consultation model in the Gamble's study, and the control group got routine care. Data were collected using the Beck Anxiety Inventory and demographic characteristics form. The level of anxiety was measured at pre-intervention phase during the gestational ages of 34 to 36 weeks. Data analysis was performed using Chi-squared test and t-test with the help of SPSS software, version 16. P-value less than 0.05 was considered statistically significant.
Results: The mean scores of anxiety in the intervention and control groups were 6.355±3.960 and 9.822±5.420 during the gestational ages of 34-36 weeks, respectively, which represented a significant difference between the groups (P<0.001).
Conclusion: The individual counseling program provided by midwife during pregnancy resulted in reduced level of anxiety in the nulliparous women.


  1. Rahimi F, Ahmadi M, Rosta F, Majd HA, Valiani M. Effect of relaxation training on pregnancy anxiety in high risk women. Safety Prom Injury Prev 2015; 2(3):180-8.
  2. Azizi S, Molayinejad M. Anxiety status in pregnant mothers at third trimester of pregnancy and its related factors in referrals to Bandar Abbas Hospitals in 2012. Iran J Obstet Gynecol Infertil 2014; 17(122):8-15. (Persian).
  3. Shobeiri F, Taravati-Javad M, Soltani F, Karami M. Effects of progressive muscle relaxation counseling on anxiety among primigravida women referred to health care centers in Hamadan. J Educ Community Health 2015; 2(2):1-9. (Persian).
  4. Alipour Z, Lamyian M, Hajizadeh E, Vafaei MA. The association between antenatal anxiety and fear of childbirth in nulliparous women: a prospective study. Iran J Nurs Midwifery Res 2011; 16(2):169.
  5. Andaroon N, Kordi M, Kimiaei SA, Esmaeili H. Relationship between Intensity of fear of Childbirth with choosing mode of delivery in Primiparous Women. Iran J Obstet Gynecol Infertil 2017; 20(5):68-75. (Persian).
  6. Ertekin Pinar S, Duran Aksoy O, Daglar G, Yurtsal ZB, Cesur B. Effect of stress management training on depression, stress and coping strategies in pregnant women: a randomised controlled trial. J Psychosom Obstet Gynecol 2017; 4:1-8.
  7. Parsa P, Saeedzadeh N, Masoumi SZ, Roshanaei G. The effectiveness of counseling in reducing anxiety among nulliparous pregnant women. J Fam Reprod Health 2016; 10(4):198.
  8. O'Connor TG, Heron J, Glover V, Team AS. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry 2002; 41(12):1470-7.
  9. Marc I, Toureche N, Ernst E, Hodnett ED, Blanchet C, Dodin S, et al. Mind‐body interventions during pregnancy for preventing or treating women's anxiety. Cochrane Database Syst Rev 2011; 7:CD007559.
  10. Hossein Khanzadeh A, Rostampour A, Khosrojavid M, Nedaee N. Effectiveness of cognitive-behavioral education on anxiety during pregnancy and delivery method in primiparous women. J Nurs Educ 2017; 5(6):24-32. (Persian).
  11. Chambers AS. Relaxation during pregnancy to reduce stress and anxiety and their associated complications. Arizona: The University of Arizona; 2007.
  12. Gamble J, Creedy D, Moyle W, Webster J, McAllister M, Dickson P. Effectiveness of a counseling intervention after a traumatic childbirth: a randomized controlled trial. Birth 2005; 32(1):11-9.
  13. Delaram M, Soltanpour F. The effect of counseling in third trimester on anxiety of nulliparous women at the time of admission for labor. Zahedan J Res Med Sci 2012; 14(2):61-5. (Persian).
  14. Khodakarami B, Golalizadeh Bibalan F, Soltani F, Soltanian A, Mohagheghi H. Impact of a counseling program on depression, anxiety, stress, and spiritual intelligence in pregnant women. J Midwifery Reprod Health 2017; 5(2):858-66.
  15. Gamble J, Creedy DK. A counselling model for postpartum women after distressing birth experiences. Midwifery 2009; 25(2):e21-30.
  16. Shafiabadi A. Theories of counseling and psychotherapy. 21th ed. Tehran: Samt; 2012. P. 148.
  17. Hemminki E, Long Q, Zhang WH, Wu Z, Raven J, Tao F, et al. Impact of financial and educational interventions on maternity care: results of cluster randomized trials in rural China, CHIMACA. Matern Child Health J 2013; 17(2):208-21.
  18. Osman A, Kopper BA, Barrios FX, Osman JR, Wade T. The Beck Anxiety Inventory: reexamination of factor structure and psychometric properties. J Clin Psychol 1997; 53(1):7-14.
  19. Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J 2008; 66(2):136-40.
  20. Muntingh AD, van der Feltz-Cornelis CM, van Marwijk HW, Spinhoven P, Penninx BW, van Balkom AJ. Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands study of depression and anxiety (NESDA). BMC Fam Pract 2011; 12(1):66.
  21. Greenberger D, Padesky CA. Mind over mood: change how you feel by changing the way you think. New York: Guilford Publications; 1996. P. 282.
  22. Leyfer OT, Ruberg JL, Woodruff-Borden J. Examination of the utility of the Beck Anxiety Inventory and its factors as a screener for anxiety disorders. J Anxiety Disord 2006; 20(4):444-58.
  23. Beck AT, Steer RA. Relationship between the Beck anxiety inventory and the Hamilton anxiety rating scale with anxious outpatients. J Anxiety Disord 1991; 5(3):213-23.
  24. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33(3):335-43.

Quintão S, Delgado AR, Prieto G. Validity study of the Beck Anxiety Inventory (Portuguese version) by the Rasch Rating Scale model. Psicologia 2013; 26(2):305-10.