According to Laux et al (2016: 395), ‘many individuals receive their first tattoo at age 16–20 years […] with up to 36% of people younger than 40 years having at least one tattoo.’ Midwives often care for those who have or are considering body piercings, yet Hoover et al (2017: 521) found that ‘body modifications are rarely addressed at visits’, although ‘management of the piercing becomes critical […] during pregnancy and birth, lactation, or surgery.’
Unlike their counterparts a generation ago, midwives now encounter more pregnant women with tattoos and body piercings, some of which may complicate antenatal and postnatal care.
Douglas and Swinnerton (2002:1057) considered the risks of epidural anaesthesia for pregnant women with lumbar tattoos, and theorised that ‘a pigment-containing tissue core from a tattoo could be deposited into the epidural, subdural or subarachnoid spaces, leading to later neurological complications,’ but found no complications from inserting a needle through a tattoo. However, Kuczkowski (2008: 2) describes how, several hours after a healthy 34-year-old woman at term—whose lumbar area was covered with tattoos—was given an epidural, she ‘reported tenderness and burning in the lumbar area where the epidural catheter had been sited,’ although the symptoms resolved within a day.
Kluger (2010: 6) considered the link between tattoo pigment migration following epidural administration to be speculative, stating: ‘In the rare event that the tattoo cannot be avoided by the puncture, we therefore strongly suggest that the anaesthesiologist perform a neuraxial blockade through the tattoo.’
Kluger (2010:4) also reported that after the ear, the navel is the site most often pierced in women, warning that, given the abdominal distension caused by pregnancy, navel piercings and the potential gravid distension site ‘carry the risk of migration, rejection or striae/stretch mark development, as well as potential rejection of the jewellery,’ adding that, since a navel ring may impede the growing uterus, it is usually removed during pregnancy.
Kluger (2015: 113) further concluded that ‘pregnancy complications among women tattooists seem at a background level, with no argument to support that tattoo inks components/by-products could impact on the pregnancies.’ However, he suggests that further studies are warranted.
According to Armstrong et al (2006: 215), ‘[t]he most serious complication related to nipple piercings and lactation would involve aspiration of jewellery parts by an infant.’ Although they had no evidence of actual aspiration, uncoupling of barbell jewellery during nursing had occurred. Armstrong et al (2006: 215) also quoted one woman who had her nipple rings removed during pregnancy, who said that: ‘it was […] too uncomfortable. But I'm going to get them redone right after I've finished breastfeeding.’
With regards to female genital piercings, this not only raises health implications, but also legal and ethical points of which midwives should be aware. The World Health Organization (2007) classes female genital piercings as type 4 female genital mutilation, defined as ‘all other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterisation.’
Finally, what about body modification for midwives? Durant (2017) asks: ‘Should midwives have tattoos?’ As one respondent observes: ‘tattoos, piercings and hair colour does [sic] not affect intelligence, spirit or professionalism.’ A point well made.