Background: Hypotension after spinal anesthesia was very common in parturient who underwent cesarean section. There were multitude of contributing factors identified in the past. Evidences justifying perioperative anxiety on women giving birth under spinal anesthesia were lacking. This study determined the effect of preoperative anxiety and related factors on intraoperative hypotension in parturient undergoing cesarean section under spinal anesthesia in resource constrained settings. Methods: A cross-sectional study was conducted on 204 parturient that underwent cesarean section under spinal anesthesia in Gandhi Memorial Hospital from January to March 30/2022. The data collected include socio-demographic data, obstetric characteristics, status of pre-operative anxiety, and intraoperative hypotension. Binary and multivariate logistic regressions were conducted to determine the causative effect of preoperative anxiety and related factors on the degree of hypotension after inducing spinal anesthesia. Variables with a p<0.05 were considered statistically significant. Results: preoperative anxiety was observed in 45.6% of women that delivered their baby under spinal anesthesia. Anxiety (AOR:2.473, 95% CI; 1.271-4.813, P=0.02), age<25 years old (AOR:3.75, 95% CI ;1.066-13.193, P=0.039), maternal weight<60 kg (AOR: 2.154, 95 % CI ;1.000-4.638, p=0.050) and anesthesia given by less experienced anesthetists (AOR: 3.701, 95 %CI ;1.318-10.388, p=0.013) were factors associated with hypotension after spinal anesthesia in parturient. Conclusion: this study justified that preoperative anxiety had a significant role in contributing for hypotension after spinal anesthesia in cesarean delivery. Thus, anesthetists should focus on relieving perioperative stress, and appreciate the other identified factors and make necessary considerations when introducing spinal anesthesia in parturient undergoing cesarean delivery. Registration-this study was registered at research registry with unique ID researchregistry8278 and available at https://www.researchregistry.com/browse-the-registry#home/