Background: Elective cesarean section (CS) rates have increased globally, yet the psychological impact of preoperative anxiety and depression in women awaiting CS remains insufficiently studied, particularly in Middle Eastern contexts. Objective: To assess the prevalence of preoperative anxiety and depression among women scheduled for elective CS in Mosul, Iraq. Methods: A cross-sectional descriptive study was conducted from December 1, 2023, to February 15, 2024, across three hospitals in Mosul. A simple random sample of 112 women aged ≥18 years scheduled for elective CS was recruited. Data collection included sociodemographic and obstetric questionnaires and the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was performed using SPSS version 25, with anxiety and depression classified according to HADS cut-offs: 0-7 (no symptoms), 8-10 (borderline), 11-21 (clinical symptoms). Results: The mean age of participants was 29.8 ± 5.4 years. Urban residence accounted for 80.4% of participants, with 65.2% being homemakers. Previous CS history was reported in 27.7% of cases, and 22.3% had chronic illnesses. Primary indications for CS included fetal distress (42.0%), breech presentation (30.4%), and previous CS (22.3%). Clinically significant anxiety (HADS-A ≥11) was found in 37.5% of participants, while clinical depression (HADS-D ≥11) was present in 25.0%. Borderline symptoms were observed in 33.9% for anxiety and 35.7% for depression. Conclusions: A substantial proportion of women undergoing elective CS experience clinically significant anxiety and depression preoperatively. These findings underscore the need for routine mental health screening and targeted interventions in preoperative care protocols.