The fear of childbirth (FOC) is a widespread issue that affects the wellbeing of pregnant women. This study aimed to investigate the impact of FOC on the preferred and actual delivery mode of Chinese primiparous and multiparous women, by controlling for potential confounding factors using Lazarus's Theory of Stress, Emotion, and Coping. We conducted this perspective-longitudinal study included 1,288 pregnant women in late pregnancy in China. Data was collected through face-to-face questionnaires, cross-checking with electronic medical records, and the use of standardized measurement tools. The actual delivery mode was followed, and statistical analysis included univariate and multivariate regression analyses. Results showed that FOC had a positive association with preference for a cesarean section. However, neither FOC nor the preference for cesarean section resulted in higher cesarean section rates. Women who received childbirth education at hospitals had higher rates of vaginal delivery. This study highlights that FOC increases the likelihood of preferring a cesarean section, but it does not significantly impact the actual delivery mode. Further research is needed to explore the reasons behind the discrepancy between preferred and actual delivery modes and its implications.