Objective To gain an in-depth understanding of the childbirth preparation needs of pregnant couples, and to provide an empirical basis for developing a childbirth preparation management program. Methods A descriptive qualitative study was conducted. Using purposive sampling, couples receiving prenatal checkups or childbirth services at a tertiary hospital were selected for semi-structured interviews. Data were analyzed using content analysis. Results A total of 14 couples participated in the interviews. Three main themes and eight sub-themes were identified: psychological perception and information cognition needs from an individual perspective (maternal body esteem perception and autonomy needs, paternal self-efficacy needs during pregnancy, the coexisting dilemma of childbirth information overload and knowledge deficiency); emotional collaboration needs within the couple and family (bidirectional emotional supply-demand coordination between spouses, collaborative childbirth preparation needs of the couple, intergenerational collaboration needs); support needs from hospitals and the community (diversified support from hospital resources, community support with continuity across family, community, and hospital). Conclusion Pregnant couples have complex and diverse needs during the childbirth preparation process. Healthcare professionals should include both partners in childbirth preparation assessments and interventions, and establish a diversified support system. This approach aims to meet the childbirth preparation needs of pregnant couples, and optimize birth outcomes.