A few weeks ago, Cathy wrote, “Sara, what are your thoughts on tongue tie division with baby who hasn’t had vit k? If mother has made informed decision, can a medical professional decline to do division?”
Well, as is so often the case, the answer to this does depend a bit on where you are in the world. But, as I wrote in my book, Vitamin K and the Newborn, I am aware that, “many of the people who perform tongue-tie division surgery won’t carry this out on babies under 12 weeks unless the baby has either received IM vitamin K or it can be demonstrated via a blood test that the baby has an adequate blood clotting result.”
This is a really tricky situation in which a few different issues are tangled up. In most areas, parents have the right to decline prophylactic treatments such as vitamin K, but they do not necessarily have the right to demand other treatments (especially when, as in this case, they could be considered to be elective and not immediately necessary in order to preserve life) if there is deemed to be a risk factor. Many professionals will consider that a baby who has not been given prophylactic vitamin K to to be at increased risk of bleeding during procedures such as tongue tie division or circumcision and in some situations, yes, a professional can decline to perform a procedure where they think that the risks outweigh the benefits. It’s complicated, though.
I know of other (usually private) practitioners who are willing to do tongue tie surgery on babies who have not received vitamin K as long as the parents have signed a consent form, and I also know of situations where professionals have managed to avoid giving an outright ‘no’ to this request by finding a way to delay the surgery.
This is such a tricky area, and I know that opinions are divided (no pun intended). One reason that this is such a tricky subject is because we all have different perceptions about two important factors: risk and responsibility. As I also discuss in Vitamin K and the Newborn, the chance of a baby having a bleed is low, but the consequences can be very serious, so this is not an easy decision.
Timing may be a key factor here, and parents in some areas may be able to request a clotting screen in order to demonstrate that the baby can adequately clot their blood. Parents may need to pay for this privately. But it is also, as I said at the outset, a bit of a postcode lottery and, as in so many areas of maternity and newborn care, it’s worth getting in touch with local practitioners to find out what the situation is in your area.
If you’re a midwife or birth worker and you’d like to find out more about Vitamin K and get better equipped to help parents make the decisions that are right for them, I facilitate an online course on this topic, which runs from April 20-27, 2018.