Fear of childbirth (FOC) can lead to maternal distress during and after pregnancy. The aim of this randomized controlled trial (RCT) was to examine whether art therapy as an adjunct to midwife-led counseling (study group) could reduce FOC significantly more than midwife-led counseling alone (control group). The on-treatment analysis included 82 women assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ) at pre- and post-timepoints. Both treatments resulted in significantly reduced FOC and there was no significant difference between the two groups. Art therapy may be used as a tailored intervention for those women who are interested in the treatment but further research is warranted.