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Are Tattoos Compatible with Breastfeeding?

Robyn Roche-Paull
San Diego CA USA
Karen Spicer
British Columbia Canada
From: LEAVEN, Vol. 41 No. 1, February-March 2005, pp. 3-4.

Body Art has been around almost as long as breastfeeding. Tattoos have been found on Ice Age remains and Egyptian mummies. Both breastfeeding and tattooing are enjoying resurgence in popularity. More than 20 million Americans, half of whom are women, have one or more tattoos.

Leaders who work with breastfeeding mothers are noticing a rise in the numbers of phone helping and email help forms asking about the compatibility of tattoos and breastfeeding.

The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American College of Nurse-Midwives have made no statements on the compatibility of tattooing and breastfeeding. However, the books, The Breastfeeding Atlas and Maternal and Infant Assessment for Breastfeeding and Human Lactation both state that already present tattoos, on the breast or elsewhere, do not impact breastfeeding.

The word "tattoo" comes from the Tahitian word tattau, meaning, "to mark." Many women mark their bodies with tattoos to celebrate life passages, special persons, places, and things in their lives. Tattooing is also done to establish identity within a group, for spiritual reasons, beautification, and social status, as well as for cosmetic reasons (permanent makeup) and to camouflage disfigurements or scars.

Tattoos are created by injecting ink into the dermal (second and third) layer of the skin. Tattooists use a hand-held electric machine that is fitted with solid needles coated in the ink. The needles enter the skin hundreds of times a minute to a depth of up to a few millimeters. The ink that is used in tattoos in the United States is subject to FDA (Food and Drug Administration) regulation as cosmetics, but none are approved for injection under the skin. People who get tattoos should be aware that inks used by tattooists do not have specific FDA approval for tattooing.

Tattooing Is Not without Risk

It is important to screen the tattooist and the shop carefully, checking with the local health department for local laws and regulations. Tattooing is currently legal in all US states except for Massachusetts, Oklahoma, and South Carolina. It is illegal in a few US cities. It is also legal in all provinces of Canada. However, the artist training, sterilization of instruments, and inspections of the studios depend on state or provincial laws. Seventy-four percent of US states require licensing, registration, and/or permits. Reputable tattooists will follow universal precautions such as sterilization of the tattoo machine using an autoclave; single-use inks, ink cups, gloves, and needles; bagging of equipment to avoid cross contamination; and thorough hand-washing with disinfectant soap.

Many, if not most, professional tattooists will not tattoo a woman who is currently pregnant or breastfeeding. World-reknowned tattoo artist Pat Fish of Santa Barbara, California, USA says:
There is always an element of risk in getting a tattoo. The tattoo could have an adverse effect on the mother’s immune system that could be transmitted to the baby.

While the body is healing after a tattoo—and producing milk—and if the mother’s body would "reject" the tattoo, the possibility exists that it could harm the baby. This is especially a problem if the client does not follow the aftercare instructions and develops an infection. Alex Stewart of a former natural parenting Web site in the UK suggests that mothers give their bodies 18 months to fully recover from childbirth before asking it to heal a tattoo.

The general information about tattooing also applies to breastfeeding women. According to the research, local and systemic infections are the most prevalent risks of tattooing. Local infections can occur. The aftercare regimen includes keeping the tattoo clean with mild soap and water, not picking at the scabs, and keeping the tattoo out of the sun. Systemic infections occur when universal precautions are not followed by the tattoo artist and can include such diseases as hepatitis, tetanus, and HIV.

Human milk banks will not accept donations from mothers who have had a tattoo done in the previous 12 months, because of the possibility of various infections caused by blood-borne pathogens. In 1985, the Centers for Disease Control in Atlanta, Georgia, USA, issued national guidelines for protection during the tattoo process. There has never been a recorded case of tattoo-transmitted HIV infection; the last reported tattoo-related incident of hepatitis was in 1950. Furthermore, according to an informal, unpublished survey of tattooed or pierced mothers by Mary Jozwiak, IBCLC, a moderator at HipMama magazine and e-zine, the risk for blood-borne illnesses was not increased for mothers who were tattooed by a professional who followed universal precautions.

The possibility of the ink migrating into the mother’s blood plasma and then into the milk-making cells of the breast is negligible, according to Frank Nice, RPh. It is possible to have allergic reactions to the tattoo inks.

Is It Safe to Have a Tattoo Removed While Breastfeeding?

It is estimated that 50 percent of those who get tattoos later regret the decision and wish to have them removed. The medical literature says little regarding the safety of tattoo removal while breastfeeding, but the general information that is available still applies.

Tattoo removal is now accomplished with the use of lasers, specifically Q-switched lasers. The laser works by producing short pulses of intense light that pass through the epidermis to be absorbed by the tattoo pigment in the dermis. The laser energy causes the tattoo pigment to fragment into smaller particles that are picked up by the body’s immune system and filtered out. The removal process is bloodless, low risk, and has minimal side effects. The same aftercare as for a tattoo applies to its removal. A mild analgesic, such as acetaminophen, is often prescribed for the pain, if needed. Possible side effects include pigmentation changes, local infection, and possible allergic reaction to the particles of ink that circulate in the mother’s system after a laser treatment.

Mothers usually have no problems if they follow the recommended aftercare procedures. The body filters the ink particles via the white blood cells (macrophages and neutrophils), and according to Dr. Jack Newman, "It is doubtful that tattoo removal would influence breastfeeding in any way." When there are concerns about a tattoo, the mother should consult the tattoo artist or the dermatologist who performed the tattoo removal. In an emergency, she should contact her physician immediately.
There is no evidence suggesting that tattoos affect the breastfeeding relationship or have any effect on a mother’s milk. Regardless of their personal views about tattoos, Leaders can offer current information to women who are interested in tattoos.

References

Cadwell, K. et al. Maternal and Infant Assessment For Breastfeeding and Human Lactation. Sudbury, Massachusetts: Jones and Bartlett, 2002; 74.
Kuperman-Beade, M., Levine, V., and Asinoff, R. Laser removal of tattoos. Am J Clin Dermatol 2001; 2(1):21-25.
Martin, J. Is nipple piercing compatible with breastfeeding? J Hum Lact 2004; 20(3):319-21.
Millner, V. and Eichold, B. Body piercing and tattooing perspectives. Clin Nurse Res 2001; 10(4):424-41.
Mothers Milk Bank San Jose. Donor FAQ 2004. [www.milkbanksj.org]
Newman, Jack, 2004. Personal communication.
Nice, Frank J., 2004. Personal Communication.
Wilson-Clay, B. and Hoover, K. The Breastfeeding Atlas, 2nd edition. Austin, Texas: LactNews Press, 2002; 146.

Robyn Roche-Paull lives in San Diego, California USA with her husband, Stephen. They have two sons, Morgan (8) and Tiernan (18 months) and one daughter, Siobhan (5). She was accredited in 2000 and has been leading meetings in San Diego, California, USA. She is currently the Associate Area Coordinator of Leaders for the San Diego District. She has four tattoos and has breastfed successfully with them in place! Karen Spicer recently completed an international move with her family from Tokyo, Japan, where she was accredited as an LLL Leader, to a beautiful little town on the Sunshine Coast of British Columbia, Canada. She is a proud mother to a three-and-a-half year old boy, Jack Ichiro, and is expecting another baby any day now! Special thanks to Norma Ritter, Contributing Editor, who originally prepared this article for the Leaven column "Keeping Up to Date." To submit an article to Norma for "Keeping Up to Date," contact her at lllnormar at gmail dot com (email).

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