Objective: The purpose of this investigation was to assess the incidence of serious childbearing fear in a sample of American women, and to explore associations between women's experiences and fear of childbirth. Methods:Ninety women 25 weeks of gestation and later who participated in a prospective longitudinal study were administered questionnaires during pregnancy that included background factors (marital status, education, birth history), fear of childbirth, and current levels of depression and posttraumatic stress disorder symptomology. Results:The incidence of serious fear of childbirth (7.7%) was slightly lower than but consistent with studies of Northern European women. When considered separately, 11.6% of women in the care of an obstetrician and 4% of women in the care of a midwife exhibited serious levels of fear. Greater fear of childbirth was seen in women experiencing sexual assault in both childhood and adulthood but not in women endorsing childhood sexual assault alone. Fear was higher among women with a current diagnosis of depression or co-morbid depression and Posttraumatic Stress Disorder. Conclusion:These results underscore the importance of identifying and treating depression in pregnant women.