PREMATURE PERSONHOODS IN A NEONATAL INTENSIVE CARE UNIT IN AOTEAROA NEW ZEALAND BY ZOE POPPELWELL A thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy in Cultural Anthropology Victoria University of Wellington 2020 Abstract The Neonatal Intensive Care Unit (NICU) provides medical care for some of the most unwell newborns, including those born premature. Infants born prior to 28 completed weeks gestation, classified as extremely premature, often require long admissions and close management. These infants, and those who care for them, occupy a unique position of flux. The extremely premature body is not only a locus for clinical dialogue on the reach of biomedicine, but also for wider debates over the personhood of those born at the edge of viability. This thesis is an ethnographic account of some of the ways in which neonatal personhood was strategically articulated in the NICU at various points of the infant’s stay. These articulations, neither contingent nor dependent on the infant’s clinical position, illustrate a multiplicity of relational personhoods that exist alongside, and sometimes at tension with, individualised dynamics of care and emotion between infants, parents, and staff. I conducted over one year of ethnographic fieldwork, including six months of intensive participant observation at a single urban unit, and over 50 ethnographic interviews across New Zealand with a variety of individuals, such as NICU parents and staFF. A portion of this thesis is also comprised of autoethnographic vignettes that account for my own neonatal journey and position in the field. 1 I dedicate this thesis to my mum, Carolina. 2 Acknowledgements The development, research, and writing of this thesis was very much a collaborative effort at all stages. First and foremost, I offer my sincerest gratitude and appreciation to the families who generously shared their experiences with me at some of the toughest times of their lives. I would also like to thank the staff at City NICU who allowed me into their place of work and encouraged all of my research endeavours. To my supervisors Dr Catherine Trundle and Dr Annemarie Jutel, I am very grateful. Your intellectual assistance and guidance over the last few years has been invaluable and I have very much enjoyed collaborating with you both. I also wish to thank the postgraduate students and professional staff of Level 9 who have continuously helped me along the thesis journey. In particular, thank you for the coffee, intellectual debates, and yarns when they were needed the most. I am also grateful for the financial assistance provided through the Victoria University Doctoral Scholarship. Ultimately, I thank my family and friends for a lifetime of support, and without which, this thesis would not be possible. 3 Table of Contents Abstract .............................................................................................................................................................................. 1 Acknowledgements ........................................................................................................................................................ 3 Introducing an Ethnography of Premature Personhood in New Zealand .................................................... 8 Re-working Ethnography: Introducing The Practice and Product ................................................................................ 10 Thesis Outline ......................................................................................................................................................................................... 15 Chapter 1: Introducing Personhood and Contextualising Prematurity in New Zealand ..................... 20 Introducing the Anthropological Literature on (Relational) Personhood .................................................................. 20 Premature Personhood: An Epidemiological Lens ................................................................................................................. 24 Conclusions .............................................................................................................................................................................................. 27 Chapter 2: Gestation as a Metric of Personhood ................................................................................................ 31 Gestation at City Hospital and Beyond ........................................................................................................................................ 34 Pregnancy and gestation ...................................................................................................................................................... 35 Gestation as Viability? ........................................................................................................................................................... 39 Conclusions .............................................................................................................................................................................................. 42 Chapter 3: Spaces, Objects, and Persons .............................................................................................................. 45 Material Manifestations of Personhood ..................................................................................................................................... 49 From Researcher to Researched .................................................................................................................................................... 52 From Liminal Spaces to Liminal Parents ................................................................................................................................... 56 Conclusions .............................................................................................................................................................................................. 61 Chapter 4: Persons in Time ....................................................................................................................................... 63 Sociocultural Approaches to Time ................................................................................................................................................ 65 The Progress Paradigm: Time and Linearity on the NICU ................................................................................................. 69 4 Looking Forward: The Future as a Heuristic Tool ................................................................................................................. 74 Conclusions .............................................................................................................................................................................................. 79 Chapter 5: Neonatal Work and Professional Negotiations ............................................................................. 83 The Profession: A Very Brief History ............................................................................................................................................ 83 Research and Professionalisation in Neonatal Work ........................................................................................................... 85 Neonatology ............................................................................................................................................................................... 85 Nursing ......................................................................................................................................................................................... 93 Conclusions .............................................................................................................................................................................................. 98 Chapter 6: A Language of Infant Agency ............................................................................................................... 99 Diverse Theories of Agency ............................................................................................................................................................ 100 “Tough Little Buggers” .................................................................................................................................................................... 102 Affording Agency ............................................................................................................................................................................... 110 A Bounded Agency? ........................................................................................................................................................................... 118 Conclusions ........................................................................................................................................................................................... 118 Chapter 7: Personhood and Social Categories ................................................................................................. 121 Babies as Gendered Persons .......................................................................................................................................................... 123 Beyond the Clinical: From Gendering to Gender Roles .....................................................................................................