2025 Theses Doctoral

Newborn Country: Space, Place, and the Rise of Neonatal Intensive Care in the United States, 1930–1980

Bergen, Sadie

This dissertation examines how newborn medical care was institutionalized in hospitals across the United States between 1930 and 1980. Over that time, newborn medicine evolved from a relatively neglected domain of pediatrics into one of its most crowded arenas, anchored by new neonatal intensive care units (NICUs) where round-the-clock, high-tech care was provided to critically ill and premature newborns.

Rather than focusing on therapeutic developments, “Newborn Country” uses space and place as analytic optics to understand the rise of the NICU. It argues that the course of newborn medicine was set in the process of answering questions about how to construct safe hospital environments for newborns and how to distribute specialized newborn care across a fragmented national landscape of hospital-centric medicine. Specific techniques of governance, from infection control protocols to health planning agendas, as well as their uneven and often unequal application, structured the spaces of promised health and healing that American newborns and their caretakers have moved through. The transition of birth from the home to the hospital demanded new spaces for newborn care, the safety of which were quickly cast into question by epidemics of hospital-associated infections.

The organized response to these infections relied on the reallocation of hospital space through a gendered paradigm of aseptic discipline, but this paradigm fell apart in the face of hospital spaces defined by regimes of socioeconomic and racial segregation. In the 1950s, antibiotic-resistant infections in hospital nurseries challenged prevailing infection control strategies, exposing the porous boundaries between hospital environments and their surrounding communities and encouraging institutions to surveil their built and social ecosystems more actively. As antibiotic-resistant nursery infections waned in virulence in the early 1960s, freedom from the threat of infection opened the possibilities for newborn care. It facilitated new arrangements of space, labor, and neonatal patients that challenged norms of hospital safety but held immense promise for saving newborn lives.

“Newborn Country” also considers the politics of organizing and distributing specialized newborn care, beginning with systems of emergency transport organized for premature infants in the 1930s and 1940s. Both emergency medical services and specialized newborn care were caught up in a wave of enthusiasm for “regionalizing” medical services within defined geographic areas in the 1960s. Hospitals enacted “perinatal regionalization” by creating hierarchical networks of care connected by a circulatory system of newborn transportation. In the 1970s, perinatal regionalization remade geographies of care under the new banner of perinatal health. As the decade came to a close and NICUs were increasingly identified as a source of institutional profit and prestige, perinatal regionalization became a contested stage for the spatial politics of allocating hospital resources.