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In an era of low fertility and heightened demographic anxieties, Fear of Childbirth (FOC) discourse on digital platforms has become a pervasive yet understudied gender belief shaping contemporary gender dynamics in China. This study focuses on young Chinese urban middle-class women, who are active Red (Xiaohongshu) users at various stages of marriage and childbirth. Using critical discourse analysis of 187 FOC posts and in-depth interviews with 13 users, this study analyzes how market rationality shapes FOC discursively and in practice. Drawing on a life-course-informed, stage-comparative design (unmarried without children; married without children; married with children), it investigates how Red users construct FOC discourse and the gender strategies they adopt to navigate intimate relationships. The findings suggest that market rationality, embedded in neoliberal feminism circulating online, plays a key role in shaping women’s FOC. While Western neoliberal feminist discourse promotes a “have-it-all” model that links self-optimization to simultaneous career and reproductive success, evidence from urban China reveals a different pattern: life-stage self-optimization. Within a state–market–family nexus that reinforces women’s reproductive roles, many women reframe reproduction as a high-cost decision, strategically avoiding, bargaining, or externalizing it to optimize work and life across the life course. Platform cultures further intensify this cost-benefit logic to devalue reproduction and reinforce FOC. The study advances a “beyond having-it-all” proposition by examining how neoliberal feminism is locally articulated, illustrating how market rationality shapes women’s reproductive decision-making and becomes embedded in their everyday lives in urban China.