A lower back tattoo won't necessarily prevent you from having an epidural during labor. The exception would be if the tattoo is red, swollen or oozing fluid — or if the tattoo is recent and the affected skin is still healing.
Research on tattoos and epidurals is limited. Theoretical concerns — such as the development of skin cancer in the affected area years later — remain controversial. Actual reports of problems associated with epidurals and lower back tattoos are exceedingly rare.
If you have a lower back tattoo and decide to have an epidural during labor, the anesthesiologist will likely try to insert the needle through skin that isn't tattooed — such as an open area in the tattoo design.
If that isn't possible, the anesthesiologist might nick your skin before inserting the needle. This reduces any possible risk associated with trapping tattoo pigment inside the needle or depositing the pigment into deeper tissues.
Keep in mind that placing a needle through the tattoo might result in a small scar that could alter the appearance of the tattoo.
If you're concerned about the unknowns associated with tattoos and epidurals, you might ask your health care provider about other options for pain relief during labor — such as relaxation exercises, breathing techniques, or oral or injected medications.