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Background/Aims: Although maternity care in developed countries is safe, fear of childbirth is a common problem. There is limited research in this area on nulliparous and multiparous women. The aim of this study was to compare fear of childbirth, its risk factors and birth outcomes between Australian nulliparous and multiparous women. Methods: In this prospective cohort study, 141 nulliparous women and 212 multiparous women were recruited from antenatal clinics. Data were collected using standardised questionnaires and analysed. Results: A third of nulliparous (33%) and multiparous women (31%) feared childbirth. Nulliparous women with high–severe fear were more likely to have a lower family income, attend antenatal education classes, undergo assisted conception and report higher levels of depression, anxiety and stress. They also had greater odds of prelabour cervical ripening, oxytocin for induction or augmentation of labour, instrumental birth, episiotomy and greater volume of blood loss during birth than multiparous women. Conclusions: To empower and support women with fear of childbirth, their unique needs must be recognised. A assistance in coping with fear and anxiety must be made available to contribute to a positive pregnancy experience and birth outcome. [ABSTRACT FROM AUTHOR]