posttest score means for perceived stress (Table 2). This
increase in perceived stress could be attributed to fear, worries,
or concerns about an imminent labor and delivery. Although
the results of this study are encouraging, these are some
limitations that should be considered.
Some studies36,37 have found that group education appears
to provide psychosocial benefits, increase individuals’ confidence,
and provide a supportive and familiar atmosphere. In
this study, group training might have influenced results in the
experimental group (apart from the performance of applied
relaxation). Women might have learned something during the
group sessions, other than relaxation techniques, that reduced
their anxiety and perceived stress. Women might have socialized
after the training sessions, either in person or over the
telephone. These interactions could have provided social
support that reduced their anxiety and stress.
Another limitation is that the frequency of home practice of
applied relaxation was based on unverified, subjective selfreports
from each participant in the experimental group.
However, women in this study experienced a wanted pregnancy,
which could have motivated them to use the relaxation
techniques at home to ensure a healthy pregnancy outcome.
This notion is supported by the results of another study, in
which pregnant women attributed a high level of importance
to rest and relaxation, compared with other lifestyle activities,
such as physical exercise.38
Finally, long-term changes in anxiety and stress were not
assessed in this study because of time constraints on the
project. Although this may be a limitation, the findings were
statistically significant. Thus, the results of this study suggest
that teaching applied relaxation may be an efficient nonpharmacological
intervention that can promote psychological wellbeing
in anxious pregnant women, at least during pregnancy.
Long-term follow-up in future studies will be needed to
determine the duration of the effect of this intervention.
Learning applied relaxation skills could stimulate women to
become more focused on health in general, which could lead
to successful childbearing and childrearing. Therefore, it is
important to equip maternity nurses and midwives with basic
knowledge and adequate training in relaxation techniques as a
resource for improving maternal psychological health. Mental
health services should be integrated into prenatal care to
provide holistic care to pregnant women. Reducing anxiety
and stress with relaxation techniques during pregnancy could
help improve birth outcomes.9–12