Presacral masses are rare lesions and due to obscure anatomic location and etiological heterogeneity, they pose a diagnostic and therapeutic challenge. Literature is limited on the pain management of a parturient with presacral mass. We describe here a parturient in her second trimester with severe pain from a presacral mass. A high clinical acumen with early multidisciplinary involvement are needed to establish a diagnosis and provide treatment options for the well-being of the patient, minimize fetal teratogenicity, avoid chronic symptoms and long-term disability.