Claim: Women in childbirth with tattoos on their lower backs should not receive anesthetic via epidural injection.
[Collected via e-mail, 2002]
I have a tattoo on my lower back and I have recently been told that when I go into labor, that I will not be able to recieve an epidural because of this tattoo. I was told that doctors will not go through the ink in my body with the epidural needle.
[Collected via e-mail, 2005]
I've heard two times in the last month or so that women who have lower back tattoos can't get epidurals. One person I overheard said that it was because the needle wouldn't pierce the tattoo, while the other said
it was because the needle could drag ink from the tattoo into the spine.
Origins: As sacral or lumbar region tattoos have become an increasingly accepted form of body decoration, the belief that having them may negatively impact women's ability to secure anesthesia administered into the spine during childbirth has grown apace. The most common form of the rumor posits a danger of the tattoo dye being introduced into the spine by way of being pushed there by the needle used to deliver the anesthetic that blocks the
There exists a divide in informed opinion on whether such danger is actual or naught but lore. Of the various anesthetists we've canvassed in the U.S. (either directly or by way of asking their friends, family, and colleagues to quiz them on our behalf — we've apparently served to liven a number of operating room conversations), none thought administering an epidural through a tattoo in the small of the back would present any risk to the patient. Indeed, many members of the medical profession stated they themselves had performed the procedure under such conditions or had observed it being performed by others.
Those who believe epidurals through tattoos pose no danger have explained the dye used in body art becomes fixed within the tissue and so could not be dislodged by the procedure — that is, that the pigments could not travel down the epidural needle's shaft. As one anesthetist put it:
The ink in a tattoo is not in a fluid state, it has simply stained the skin, so it won't be flowing around because of a puncture. Still, you don't want skin being carried down into the spine anyway, so anesthesia equipment is designed to slice through the skin and not carry pieces down with it.
The claim that the equipment used to administer drugs spinally is fashioned in such a way as to keep foreign matter from being introduced is supported by other sources:
Much of the discussion involved the phenomenon of "coring," by which the passage of a hollow bore needle through the dermis may theoretically introduce pigmented tissue into the epidural, subdural, and/or subarachnoid spaces. However, the vast majority of epidural and spinal anesthetics are administered via styletted needles and the stylets are not removed until the needles have passed through the superficial layers, making this scenario very unlikely.
Yet while the risk of introducing tattoo dye into the spinal column along with the syringe used to administer an epidural is apparently roundly dismissed in the U.S., in Canada it is being considered as a possibility, even to the point that some doctors are refusing to perform the procedure through inked-on body art. Alberta RN, a Canadian publication, noted in 2004 that:
Reliable studies are not yet available on the long-term effects of dyes and heavy metals dragged into the epidural and subarachnoid spaces. Anesthesiologists are increasingly concerned about the safety of inserting needles and epidural catheters through tattooed areas and in some situations, anesthetists will refuse to perform epidurals if they can't find tattoo-free skin to go through.
In similar vein, a February 2005 segment of the CTV Evening News hosted by Sarah Galashan, its bureau chief in Alberta, focused on the potential risk of paralysis "depending on the chemicals in the dye and whether or not they might somehow seep into the lower lumbar, thereby affecting the nervous system." Said anesthesiologist Dr. Mark Kostach of Calgary, "There will be people that may recommend that you don't get an epidural. I'm not sure anyone in our group would absolutely refuse, but it would be an added risk that we'd have to talk about with patients."
Body decoration by inking has its pitfalls. Hepatitis is easily passed to the art wearer because it is a hardy virus that can live for weeks outside a human host and so can survive on tattooing implements that have not been carefully cleaned. Another negative, one less known among tattoo seekers, concerns Magnetic Resonance Imaging (MRI). Because some tattoo inks contain metal fibers such as iron oxide which can cause intense skin burning and swelling during MRI procedures, some radiology departments are refusing to perform these scans on patients who have tattoos.
Whatever the medical world ultimately determines as the truth about potential risk regarding the combination of sacral tattoos and epidurals, I can't help but be struck by the parallels between the modern rumor about inked vixens having to give birth unbuffered by pain medications and the penalty visited upon Eve for leading Adam astray. Eve, the original bad woman, the vamp, was punished for her part in the "Have an apple, sweetheart" fiasco by being cursed by God on high with the pain of childbirth, with the whammy laid upon her passed down to all her descendents (that is, all womanhood). Lumbar region tattoos on women are seen as communicating hinted-at promises of sexual favors. The consequence visited upon both classes of temptress is the same: they shall each know the physical pain of birthing children.