Objective To investigate the effect of careful nursing on improving prenatal self-efficacy in puerperae with gestational hypertension. Methods 84 cases with gestational hypertension in our hospital from January 2016 to December 2016 were randomly divided into the control group and the observation group, 42 cases in each group, the control group was given routine nursing before delivery, and the observation group was given careful nursing before delivery. Selfefficacy and antenatal nursing satisfaction of the two groups were observed and recorded. Results After nursing, selfefficacy expected score of the observation group (85.22±5.24) was significantly higher than that of the control group (61.36±5.69), after nursing, the observation group (88.36±6.49) was also higher than the control group (68.26±7.47), the difference was statistic significant by T-test (P<0.05). During the hospital stay, nursing satisfaction of the observation group (100.00%) was significantly higher than that of the control group (71.43%), the difference was statistic significant by χ2 test (P<0.05). Conclusion The application of careful nursing on puerperae with gestational hypertension can improve labor self-efficacy, guarantee maternal and child safety, it is worthy of clinical promotion.