What it is
The pudendal block was widely used before epidurals were common; it's less used now but still valuable when a regional block isn't in place and rapid perineal analgesia is needed — often for operative vaginal delivery (vacuum/forceps) or extensive repair. Performed by the OB through the vaginal wall.
Evidence review links
Each link opens the full review on the publisher's site in a new tab.
Possible benefits
- Fast, targeted numbness for delivery or repair without a regional blockReview sources ↓
- Doesn't affect labor progress or maternal mobility significantlyReview sources ↓
Possible risks
- Occasionally incomplete block (works on one side only)Review sources ↓
- Rare hematoma or nerve injuryReview sources ↓
Alternatives
- Local perineal infiltrationReview sources ↓
- Existing epidural (topped up)Review sources ↓
- Spinal or general anesthesia for larger proceduresReview sources ↓
Current evidence
ACOG obstetric anesthesia guidance includes pudendal block as an option; overall use has declined with widespread epidural availability.
Where the evidence is clear · where people may choose differently
For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.
Educational only. Your care team can help you weigh what applies to your specific situation.
Related evidence topics
- Local Anesthetic (Perineal Infiltration)Injected lidocaine to numb the perineum for repair of tears or episiotomy after birth.
- Vacuum vs. Forceps (Operative Vaginal Birth)Instruments used to help the baby out during pushing, usually when the baby is close but not quite born and there's a reason to speed things up.
- Epidural AnesthesiaRegional anesthesia delivered through a small catheter in the lower back to numb pain from the waist down during labor.
- Pain Management OptionsAn overview of non-pharmacologic and pharmacologic comfort options.
Questions to ask your care team
- ?When would you use a pudendal block vs. topping up an epidural?
- ?What are the risks compared to spinal?
Universal questions (works for any decision)
A short BRAIN-style set you can bring to any conversation about interventions, monitoring, or care decisions.
- ?Why are you recommending this now — is it urgent, routine, or optional?
- ?What happens if we wait an hour (or longer) before deciding?
- ?What signs would tell us this is working — or that we need to change course?
- ?What are the alternatives, including doing nothing?
- ?What would you recommend if this were your family?
- ?What would change your recommendation?
Sources & provenance
Tap a source to open the original guideline or review in a new tab.
Plain-language paraphrase. Re-verify before publish.
Last reviewed: 2026-07-03
Further reading — canonical references
Read the source material directly. Each link opens the publisher's own current guidance in a new tab — cross-check what we summarize against what they say.
Tier 1 · Clinical guidelines
Tier 2 · Systematic reviews
Educational only. Guidelines evolve — the linked publisher pages will reflect newer guidance than any static snapshot.
Version history — v1.0.0
v1.0.0 · 2026-07-03 · LlaMamma editors
Initial pudendal block topic.
New guidance from ACOG, WHO, Evidence Based Birth, or other listed sources is recorded here and can be updated remotely without a new app release.