To compare obstetric outcomes for women with fear of childbirth who received counseling during pregnancy with women without fear of childbirth. Design. Descriptive, retrospective case-control study. Setting. University Hospital, Linköping, Sweden. Sample. 353 women who were referred to a unit for psychosocial obstetrics and gynecology because of fear of childbirth constituted the index group and 579 women without fear of childbirth formed a reference group. Methods. Data were collected from standardized antenatal and delivery records. Main outcome measures. Delivery data. Results. Elective cesarean sections (CS) were more frequent in the index group (p<0.001). Induction of delivery was also more common among the women with fear of childbirth (16.5 compared with 9.6%, p<0.001). Women with fear of childbirth who were scheduled for vaginal delivery were more often delivered by emergency CS (p=0.007). Elective CS was more common among the parous women with fear of childbirth and instrumental delivery was more common among nulliparous women with fear of childbirth. There were no differences in complications during pregnancy, delivery or postpartum between the two groups. Conclusion. Fear of childbirth is a predisposing factor for emergency and elective CS even after psychological counseling. Maximal effort is necessary to avoid traumatizing deliveries and negative experiences, especially for nulliparous women.