Objective. To investigate Swedish women's level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section. Design. A cross-sectional study. Setting. All antenatal clinics in four geographical areas. Sample. Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during September–October 2006. Method. A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Main outcome measures. The level of fear of childbirth and preferred mode of delivery. Results. Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score ≥85) was 15.8% and very intense fear (tocophobia) (W-DEQ score ≥100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.1–22.59 for nulliparous and OR 8.32, 4.36–15.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.55–35.97), or an instrumental vaginal delivery (OR 2.34, 1.02–5.34). The level of fear of childbirth was not associated with the gestational age. Conclusions. When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.