Background: Fear of childbirth (FOC) is becoming more widely acknowledged as a critical psychological health issue among expectant mothers worldwide. Aim: To assess effectiveness of prenatal counseling program on improving childbirth fear and self-efficacy among primigravida women. Design: A pre- and post-test randomized controlled design with two groupings that are parallel was utilized. Setting: The research was conducted at the department of Obstetrics and Gynecology antenatal clinic at Damanhur Educational Hospital. Subjects: A purposive sample of 120 primigravidas was involved (60 in each group). Tools: Four tools were employed in the process of gathering data. Tool (I) Structured interviewing questionnaire, Tool (II): Wijma Delivery Expectancy/ Experience Questionnaire (WDEQ-A), Tool (III) Childbirth Self-Efficacy Inventory (CBSEI), Tool (IV) Childbirth preference. Results: The study group has lower childbirth fear with a mean of 51.7±19.3 compared to the control group mean of 84.1±24.7 and higher childbirth self-efficacy with a mean of 247.9±26.6 compared with the control group mean of 213.8± 32.8.Conclusion: There was an improvement in childbirth fear and childbirth self-efficacy among primigravidas following the counseling program that promoting preference of vaginal delivery over cesarean section. Recommendations: Prenatal counseling about labor and birthing process should be integrated into routine prenatal care among primigravidas.