Obstetric and Anesthetic Implications of "Body Art" (Piercing and Tattooing)

William Camann, MD

Disclosures

April 03, 2006

In This Article

General Comments

The practice of body modification -- whether to achieve personal beauty or satisfaction, express individuality or cultural acceptance, or to enhance sexual satisfaction -- is an ancient practice. "Body art" has become an increasingly common fashion trend among men and women today. Decorative and permanent body modification is now accepted in most circles as a relatively mainstream practice, and most practicing obstetricians and anesthesiologists will see patients with body art on an almost daily basis.[1] This review highlights some of the issues that may be of concern when a patient with body art presents for obstetric care.

Body piercing may cause, or be associated with, localized infections or cellulitis, as well as bloodborne transmission of agents such as hepatitis B and C and HIV. Although most (but not all!) piercing parlors practice sterile technique, the risk of infection is always cause for concern. In addition, although the body art may not be a direct source of infection, the practice of body modification itself may serve as a proxy indicator for other high-risk behaviors. This association may become less of an issue as body art becomes more mainstream; yet, the index of suspicion should always be increased, particularly in the adolescent population.[2]

The earlobe is the most common site for piercing, and owing to its commonality and low-risk profile, will not be discussed further. Women who are considering getting a piercing in other body areas during pregnancy should be counseled about the expected changes in body size and shape, which may have implications for fit and hole size. A new piercing during pregnancy is not advised, and patients should be counseled about potential risks. This review will focus on piercings that have preceded pregnancy and have already healed. Piercing locations that may be of interest to obstetricians and anesthesiologists are discussed.

Piercing of the nipples can be associated with mastitis, galactorrhea, damaged milk ducts, and difficulty breastfeeding. It is likely that most women would choose to remove nipple jewelry during breastfeeding. Nonetheless, a careful history and physical examination may reveal nipple piercings (even if previously removed) as a source of infections or other difficulties with breastfeeding. Notably, there is a report of the use of nipple rings as a treatment for inverted nipples, enabling breastfeeding to proceed.[3] The presence of a nipple piercing does not automatically rule out breastfeeding; many women with nipple piercings can and do successfully breastfeed. Individual judgment, proper attention to hygiene, and personal comfort would seem to dictate the most acceptable approach. An additional consideration would be the potential for the piercing to become dislodged and create a choking hazard for the infant.

The "belly-button" ring is becoming one of the most common piercing sites for young women. The obvious problem with navel piercing relates to alterations in abdominal girth as pregnancy progresses. (A very common physiologic change associated with pregnancy is the well-known transition from the "inny" to the "outy"!) This will often result in discomfort or altered fit of a navel piercing. Patients should be counseled to consider removing navel piercings once discomfort begins and to have a heightened index of suspicion for infections, necrosis, or other skin changes at or near the site of the piercing. Some women may choose to use one of a variety of commercially available flexible plastic (polytetrafluoroethylene) space-holders during the latter months of pregnancy. In addition, some women who lack sufficient tissue quantity or pliability to receive a navel piercing before pregnancy may well be able to do so afterward. If a patient presents in labor with a navel piercing in place, it should be removed, especially if a cesarean delivery is anticipated.

Piercing in the genital region could, theoretically, damage barrier contraception and lead to unwanted pregnancy or transmission of sexually transmitted diseases. Although not documented, genital piercing may increase the risk of severe lacerations during labor and delivery.

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