To explore the effects of painless delivery combined with midwifery based on the theory of planned behavior for primiparas during delivery on their bleeding volume, perineum injury and delivery pain. Methods: A total of 92 primiparas who wanted painless delivery in hospital were selected and were divided into intervention group (46 cases) and control group (46 cases) by random number table method from August 2021 to July 2022. The primiparas in the control group were given routine delivery care. The primiparas in the intervention group were given painless delivery combined with midwifery based on the theory of planned behavior. The bleeding volume, the labor process, the perineum injury, the SF-MPQ scale score and the comfort of the primiparas were compared between the two groups. Results: The bleeding volume of the primiparas in the intervention group in 2 h after delivery (185.96±13.47 ml) and 24 h (216.15±21.09 ml) were significantly less than those (243.11±25.53 ml and 291.66±29.25 ml) of the primiparas in the control group. The durations of the first, the second and the third stages of labor of the primiparas in the intervention group were significantly shorter than those of the primiparas in the control group, and the perineal damage situation of the primiparas in the intervention group were significantly less. The visual analogue score by SF-MPQ scale (3.15±0.88 points), the pain grading index score (16.32±2.57 points) and the pain intensity score (1.83±0.45 points) of the primiparas in the intervention group were significantly lower than those (4.67±1.12 points, 20.81±5.09 points and 2.47±0.62 points) of the primiparas in the control group. The comfortable condition rating scale score of the primiparas in the intervention group was significantly higher than that of the primiparas in the control group (all P＜0.05). Conclusion: The painless delivery combined with midwifery based on the theory of planned behavior for the primiparas during delivery can reduce their bleeding volume and perineum injury, alleviate their pain and improve their physical and mental comfort.