Background and objective: Childbirth fear is a major problem for women, as it results in avoidance of maternity, women & fetal stress and raise in women requests for cesarean delivery. The aim of this study is to investigate factors associated with fear of childbirth (FOC), and its effect on women’s preference for elective cesarean section (CS). Methods: Design: Cross sectional descriptive design. Setting: Study conducted at five obstetrical and gynecological private clinics in El-Mahalla El-Kobra city. Subjects: A purposive sample consisted of 205 pregnant women selected according to the inclusion and exclusion criteria. Tools: Three tools were used for data collection (Structured Interview Questionnaire, Melender (2002) Questionnaire to measure childbirth fear associated factors and Childbirth Attitudes Questionnaire). Results: Revealed that 47.8% of pregnant women preferred elective CS. Fear of vaginal birth, safer mode for the baby, no influence on postpartum sexual life and pain associated with delivery were the most reasons for CS preference. Childbirth factor was the highest factor associated with FOC with mean ± SD 12.439 ± 3.949. Fear of pain, episiotomy and lacerations were the highest sub factors representative for childbirth factor (89.3%, 83.9%, and 82.4% respectively). The highest cause of FOC was negative mood with mean ± SD 13.302 ± 3.500. 50.0% of pregnant women with high FOC preferred CS. Conclusions and recommendations: Childbirth factor was the highest factor associated with FOC. Fear of pain, episiotomy and lacerations were the highest sub factors representative for childbirth factor associated with FOC. Pregnant women with high fear of childbirth preferred cesarean section. Recommendations: Undertaking information, education and communication programs to increase awareness of the women, husbands, health providers and society about childbirth fear and its effect on cesarean section preference in order to decrease elective cesarean section rate