Objective: To evaluate the relationship between specific pelvic floor–related fears and mode of delivery preference in primigravid women, and to determine the independent effect of these fears on cesarean preference. Design, Setting, Population: Cross-sectional group-comparative study conducted at a tertiary obstetrics center including 510 primigravid women at 32–35 weeks of gestation. Participants were classified into three groups based on delivery preference: vaginal, cesarean, and undecided Methods: Pelvic floor–related fears were assessed using a structured scale with four subscales. A total concern score (0–40) was calculated. Associations between delivery preference and fear scores were analyzed using appropriate statistical methods. Main Outcome Measures: Primary outcome was preference for cesarean delivery. The main exposure variable was the total concern score; subscale scores were evaluated secondarily. Results: The total concern score differed significantly across delivery preference groups (p=0.002) and was higher among women preferring cesarean delivery. Significant differences were observed for fears of urinary incontinence (p=0.001) and perineal deformity (p=0.015), while other subscales were not significant. ROC analysis showed limited discriminatory performance (AUC=0.586; p=0.003). In multivariate analysis, a total concern score ≥25.5 independently increased the likelihood of cesarean preference (OR=1.41; 95% CI: 1.01–2.08; p=0.048). Conclusions: Pelvic floor–related fears significantly influence delivery preferences in primigravid women, with the total concern score emerging as an independent predictor of cesarean preference. Addressing these fears during antenatal care may help reduce non-medically indicated cesarean rates. Funding: No funding was received for this study.