Changes in facial expression have been shown to be a useful tool to assess pain severity in humans and animals, but facial scales have not yet been developed for all species. A facial expression scale in sows was developed using farrowing as a pain model. Five potential facial zones were identified: (i) Tension above eyes, (ii) Snout angle, (iii) Neck tension, (iv) Temporal tension and ear position (v), and Cheek tension. Facial zones were examined through 263 images of a total of 21 sows at farrowing, characterizing moments of non-pain (19 days post-farrowing; score 0), moderate pain (time interval between the delivery of two consecutive piglets; score 1) and severe pain (during active piglet delivery; score 2). Images were evaluated by a “Silver Standard” observer with experience in sows’ facial expressions, and by a group of eight animal welfare scientists, without experience in it, but who received a one-hour training session on how to assess pain in sows’ faces. Intra- and inter-observer reliability of the facial expression ranged from moderate to very good for all facial expression zones, with Tension above eyes, Snout angle, and Neck tension showing the highest reliability. In conclusion, monitoring facial expressions seems to be a useful tool to assess pain caused by farrowing.