This cross-sectional study compared cognitive-related variables for caesarean delivery in a private and public hospital in Tehran and assessed their association with maternal preference for delivery mode. A sample of 300 pregnant women in their final trimester of uncomplicated pregnancy was recruited from 1 private and 1 public hospital. They completed the Fear of Pain, Childbirth Attitude and the Pain Catastrophizing Scale questionnaires, and their sociodemographic data and delivery preference were recorded. Maternal preference for caesarean delivery was significantly higher in women in the private hospital, and they were significantly more likely to fear pain and childbirth than those in the public hospital; however, both were equally likely to catastrophize in painful situations. Women’s preference for caesarean delivery in both hospitals was significantly associated with all the cognitive factors. Other factors are likely to contribute to the difference in caesarean delivery in the private and public hospital.