Background: poor pregnancy QoL is associated with adverse outcomes.Objective: To examine the effect of integrating midwifery counseling with spiritual content on improving the antenatal quality of life. Method: This randomized controlled trial was carried out on 60 first time pregnant women who were referred to two childbirth preparation centers in Zanjan city, Iran in 2019. The counseling was conducted in eight sessions. The quality of life was measured before and two months after the intervention. Data were analyzed using the chi-square test, independent t-test, paired-samples t-test, and linear regression model. The level of significance was p< 0.05.Results: After intervention based on an independent t-test the total score of QoL was significantly greater in the intervention group compared to the control group (p=0.001). after the intervention the mean score of four domains of QoL (Role-Physical, General Health, Vitality, Role-Emotional, and Mental Health) was significantly higher than the control group(p=0.001). While in terms of Physical Functioning, Bodily Pain and Social Functioning domains were not statistically significant (p>0.05).Conclusion: Integrating midwifery counseling with spiritual content had a positive impact on improving the psychological aspect of quality of life more than the physical aspect. It can be used by providers for planning childbirth package.Trial registration: The study registered at the Iranian Registry of Clinical Trials website under the code IRCT20150731023423N12, Registration date: 2018-11-06, started recruitment start date: 2018-11-11(https://en.irct.ir/user/trial/32031/view)