I am often asked about vitamin K and tongue tie division. In one example, 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. And many other factors affect the availability of health care, as we have learned from the measures taken in an attempt to reduce the spread of the SARS-CoV-2 virus.
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. Parents have the right to decline prophylactic (preventative) treatments such as vitamin K. But they do not necessarily have the right to demand treatments, such as tongue tie. That’s especially the case with treatments considered to be elective. (Elective means that they are not immediately necessary in order to preserve life.) And it’s even more the case if a baby is felt to be more at risk from the procedure.
Here’s why. All procedures carry risk and possible side effects. Professionals should discuss the risks and benefits of a procedure with you. Then you can decide if it’s something you want or not. That’s a cornerstone of good practice and it’s there so that people can make informed decisions. But it’s not just up to the person themselves. Professionals have an obligation to avoid doing things that are dangerous, generally unless they are life-saving. This can put them in a really tricky position when people ask for elective procedures in circumstances that they think are too risky. A professional is responsible for their own practice, and can be punished if they do not follow appropriate law and codes.
Many professionals consider that a baby who hasn’t received vitamin K is at increased risk of bleeding during elective procedures. (Another example of an elective procedure done in some countries where babies are expected to have been given vitamin K is circumcision). Some consider that the risk is more than they feel comfortable with. As a professional, they are obliged to follow their code of conduct. And that’s why, in some situations, a professional can decline to perform a procedure.
It’s complicated, though. It is sometimes possible to find a practitioner (sometimes privately) who is willing to perform tongue tie in a baby who hasn’t had vitamin K. Some will perform tongue tie surgery on babies who have not received vitamin K if parents sign a consent form. Sometimes, health systems manage 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. 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. So it’s worth getting in touch with local practitioners and/or other birth workers to find out what the situation is in your area.
If you’re a midwife or other birth worker and you’d like to learn more about vitamin K and discuss how to best share information with parents-to-be with colleagues from around the world, we are offering Sara’s Vitamin K and the Newborn online course from June 12-19. Or see details of our other online courses!