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Law enforcement presence and policing in the hospital have been increasingly reported in response to rare but significant incidents of violence in the hospital. (1)(2) The patterns of policing in the hospital have been shown to be racialized. (1) Specifically, inequitable policing can manifest as disproportionate use of physical restraints, security calls, and hypersurveillance of racially marginalized communities. (3)(4)(5)(6)(7) These racialized patterns are not coincidental but instead reflect the systemic nature of structural racism. Structural racism is a form of racism that is “pervasively and deeply embedded in systems, laws, written or unwritten policies, and entrenched practices and beliefs that produce, condone, and perpetuate widespread unfair treatment and oppression of people of color, with adverse health consequences.” (8) Policing in the hospital has the potential to have negative effects on physical and mental health of patients, families, and staff as well as social, legal, and ethical effects on overall individual and population-level well-being. (9)Although policing is a known phenomenon in health-care settings, there are less published data on the manifestation of policing in specific locations of care, such as the NICU. This is likely because of underreporting or understudying rather than a true absence of policing in this space. A recent study by the authors (K.K., E.R.) demonstrated that structural racism can be operationalized in the NICU by examining differences in adverse social events by racialized groups. (10) In this single-center study, although policing events were uncommon, Black and indigenous families were at higher risk of policing through surveillance and action, such as security emergency response calls to the bedside, infant urine toxicology screening, child protective service referrals, and behavioral contracts. (10) Behavioral contracts are agreements drafted by health-care systems used to monitor patient behaviors determined to be problematic, which can be considered a form of policing. (11)(12)(13)(14)In this article, we present a relevant case of policing within the NICU, considerations for critical thinking and perspective taking by health-care workers, a historical review contextualizing policing in the United States and its hospitals, and contemporary solutions for health-care providers, systems, and our broader society.This article’s guest expert is Dr Amber McZeal. Dr McZeal is a depth psychologist with an emphasis on somatic, community, liberation, and indigenous psychologies. Depth psychology asserts an approach that looks beneath the surface of experience to reach the root cause of phenomena. In the case of racial disparities in maternal care and outcomes, she has focused her research on unpacking the institutional practices that have distorted birthing in North America through the lens of capitalism and coloniality. (15)(16) In addition, Dr McZeal was invited to be a community mediator for the family in the following case.A 34-week gestational age male infant was born to a Black couple after the pregnant individual, who identified as a woman and mother, presented to the labor and delivery department with decreased fetal movement. Result of fetal ultrasonography was unremarkable. The pregnant woman was then admitted to the hospital for monitoring. An urgent cesarean section was performed several days later as a result of a non-reassuring fetal heart rate tracing. At birth, the infant had respiratory failure and pulmonary hypertension, requiring intubation, surfactant administration, high-frequency ventilation, and inhaled nitric oxide. The medical team conveyed the severity of his illness to his parents, including that he required “maximum support,” and that the infant may die. The infant eventually weaned from respiratory support, began to take oral feedings, and was discharged from the hospital at 35 days of age. The infant was readmitted 3 days later for severe respiratory distress. Given his unexplained and high severity of illness at birth and continued need for respiratory support, with an evolving chest radiograph consistent with interstitial lung disease, the diagnostic evaluation at that time included a lung biopsy; he was diagnosed with pulmonary interstitial glycogenosis. He was discharged from the hospital with a nasal cannula after another month-long hospital stay.Early in the birth hospitalization, the parents disclosed their previous medical, childhood, and psychological traumas, subsequent mental health challenges, and a lack of support from the medical establishment throughout their lives to the NICU social worker. Electronic medical record (EMR) documentation during this hospitalization detailed the family's early concerns about inadequate and infrequent communication between the family and the medical team: “I have not been cared for, my voice has not been heard.” In contrast, the medical team documentation reports regular communication with the family. The family brought in a community mental health support person with whom they had an existing relationship before the delivery to help them express their concerns and needs regarding poor communication with the health-care team. The family was connected to the support person through Black Infant Health, a state-funded organization that supports and advocates for black pregnant persons and their families before and after birth. (17) Over several meetings with patient relations and hospital management, strategies to improve communication were discussed but according to the family were not satisfactorily implemented. The mother expressed, and it is documented in the EMR, that she felt her family was being treated differently than other families because of their race. After recurrent instances of her infant being fed a bottle when it was her plan to breastfeed, followed by apologies from the medical team and repeated feeding with the bottle, the mother threw a plate of food against a wall in the NICU. Management was called and she was presented with a behavioral contract to discourage further incidents of displayed behaviors of emotions. She was also told that if there were any further incidents, security would be called, and her presence at the bedside could be limited. A community “mediator,” Dr Amber McZeal, was called on to attend future family meetings, and the family was discharged from the hospital several days later.Addressing overpolicing in maternal health settings is a historical intersection that is often overlooked in contemporary social justice dialogs. The policing of Black bodies–the monitoring, surveilling, controlling, and extraction of life force–was a central feature of chattel enslavement in the United States, otherwise termed colonialism. Colonialism describes the presence of colonial administrative structures within countries that are under a dominant rule by an external political force. In the United States, those external political forces included nation-states like England, France, and Spain. The cultural and political ideologies, values, and propaganda used to realize this colonial vision is survived by a philosophical paradigm called coloniality–the long-standing patterns of power that emerged as a result of colonialism, and that define culture, labor, intersubjective relations, and knowledge production. Coloniality is, in part, maintained alive in books, in the criteria for academic performance, in cultural patterns, in common sense, in the self-image of peoples, and in aspirations of self. (18) Racialization—the devaluing of Black life justified by the notion of racial difference, and invention of racial categories in the sociopolitical sphere—not only survived colonialism’s end, it progressed through history as a naturalized phenomenon. Racialization was a product and pillar of colonialism. (19) I believe that in this infant’s case, policing of the family’s behaviors and pathologizing justified displays of emotion manifested as a behavioral contract and a threat to call security. Others and current hospital policies or practices may interpret this physical display of emotion as justified policing. I challenge you to consider throwing an inanimate object at an inanimate object after receiving bad news as a display of human emotion rather than a threat to the security of any person in the room. The racialization of the family and the history of colonialism that has created a norm of policing of Black bodies interpreted as threatening informs the interpretation of the act as a security threat.Applying a decolonial lens to address overpolicing of Black and Indigenous birthing women highlights a few key elements for consideration: the legacy of anti-Black socialization; the historical context of bodily transgression as central to colonization; the connection between birthing and exploitative racial capitalism; (15)(16) and the repression of care necessary to realize colonialism and sustain coloniality. By a robust care ethic, I suggest considering those core principles necessary to maintain mutual human dignity within social relations when providing care. Thus, the agency to breastfeed one’s child—understood within the context of ancestral memory of the gross distortion of birthing and mothering within slavery (15)(16)—insists on a historically informed care approach among healing practitioners. Choosing to dismiss a birthing mother’s care strategy holds far more gravity when viewed through a decolonial lens.In the case presented, a greater care ethic may have contributed to more humane and dignified outcomes for the family involved. Actions informed by this quality of care may have included acknowledging the family’s distrust of medical institutions and increasing communication; honoring a parent’s wishes regarding the infant’s feeding; depathologizing what I believe is justified anger when those wishes are ignored; approaching this incident with the understanding that access to the full range of human emotions, including anger, is a humanizing practice which disrupts historical and ancestral reductions; and actively engaging in repairing transgressions. If practiced, a greater care ethic may prevent harms from occurring in the first place, and repair harms that do exist. In contrast, I invite you to consider an extreme version of a robust care ethic that is practiced when providing “VIP treatment” to individuals who have power over a hospital or health-care workers or have other social capital.Early in the hospitalization, the family disclosed their past history of trauma, medical, and mental health needs that were met by the medical field during the rest of the hospitalization with consistent dismissal and neglect, resulting in policing. This pattern mirrors the historical practices of the medical system for Black birthing people: late stage colonialism, undergirded by an unrelenting ambition for capital accumulation, was host to medical apartheid practices, which positioned enslaved women’s bodies as the test site from which the field of medicalized birthing would emerge. This is history repeating itself in a cyclical way. The repetition of dehumanizing beliefs, attitudes, and actions is what constitutes coloniality as a logic permeating not only culture, but institutional spaces. 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In addition, in stage of the justice racial and have been from racial and hypersurveillance to a robust of structural racism. 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