AimsTo assess the prevalence of tokophobia (fear of childbirth) and evaluate the relationship between catastrophic thinking, tokophobia, childbirth preferences and the health profile of primigravida (first‐time pregnant women in rural areas).DesignA descriptive correlational study.MethodThis study, implemented from January 2024 to March 2024, involved 300 primigravidae. Data collection was carried out using the Socio‐Demographic and Clinical Data Sheet, the Pain Catastrophising Scale (PCS) and the Fear of Childbirth Scale, which are specific tools chosen for their relevance to the research objectives.ResultsThe mean score for catastrophic thinking is 36.13 (SD = 4.2740), which indicates a clinically significant level of pain catastrophising, and Tokophobia's mean is 42.53, which denotes intense Fear of Childbirth. There are strong positive correlations among catastrophic thinking and its subcomponents, positive correlations between tokophobia and devastating thinking and significant correlations between childbirth preferences and catastrophic thinking.ConclusionThis study's findings provide compelling insight into the intricate interplay between catastrophic thinking, tokophobia and childbirth preferences. These insights can pave the way for targeted psychological interventions to address catastrophic thinking in pregnant women, potentially alleviating tokophobia and supporting informed, less fear‐driven childbirth decisions. This could lead to a more positive childbirth experience for many birthing people, equipping healthcare professionals with actionable knowledge to improve maternal and child health outcomes.Reporting MethodThe relevant reporting method, that is, STROBE, has been adhered to.ImpactThis study's findings have significant implications for the healthcare of pregnant women, particularly first‐time birthing people deemed high risk. The study suggests that thorough antenatal care can help ease their fear of childbirth, ultimately leading to improved outcomes for both women and babies.Patient or Public ContributionPublic contribution by females in the community maternal services.