The neonatal intensive care unit as a site of perinatal iatrogenesis: An ethnographic analysis of postpartum health support in a U.S. children's hospital

Postpartum parents with infants in neonatal intensive care units (NICUs) disproportionately lack access to adequate postpartum care, particularly in pediatric hospital settings. Building upon Liese's (2021) framework of obstetric iatrogenesis ‘ranging from unintentional harm (UH) to overt disrespect, violence, and abuse (DVA)’, this paper proposes an extended analytic of perinatal iatrogenesis. It explores how the experiences of postpartum parents in the NICU exemplify perinatal iatrogenesis, highlighting how iatrogenesis manifests beyond birth and in non-obstetric settings, ultimately contributing to worse health outcomes for postpartum persons. Drawing on twelve months of ethnographic observations between 1/31/2023 and 1/31/24 and 30 semi-structured interviews in a large, urban children's hospital Level IV NICU in the Northeastern U.S., this analysis positions the NICU as a site of perinatal iatrogenesis, exposing how neglectful and inaccessible postpartum care for NICU parents is a normalized form of mistreatment of perinatal persons within the U.S. healthcare system. It also argues that the embodiment of societal notions of motherhood reduces maternal motivations for self-care, contributing to postpartum care underutilization among NICU parents. Centering the postpartum period as key for maternal health and dyadic health, this paper demonstrates the utility of the perinatal iatrogenesis framework for understanding maternal experiences in the NICU and advocates for improved postpartum health support for NICU parents in a pediatric hospital setting.