Coming Home to Birth

How Alaska’s Indigenous Birthworkers Are Reclaiming Ceremonial Care

A Yup’ik mother finds strength in tradition — and hope for a future where Indigenous birth is no longer separated from culture, community or care.

Story by Elyse Wild

ANCHORAGE — On Feb. 12, 2023, Chante Tran (Yup’ik) awoke in the middle of the night to an unmistakable sensation. She rolled out of bed and grabbed a cloth to stem the flow of amniotic fluid between her legs — her water had broken. It was time to meet her baby.

Twenty minutes later, Tran sat in the passenger seat, her belly swollen with life, while her husband Chris drove them to the Alaska Native Medical Center in Anchorage. West Tudor Road was nearly empty, save for their car. As snow streamed from the dark Alaska sky, she felt they were the only people in the world.

“It was like our little bubble of serenity,” she told Native News Online in April 2025. “I was tired, but at peace and excited.”

That sense of peace was hard-won for Tran, whose birth experience is part of a growing movement to address a maternal health crisis among Alaska Native women. Throughout her pregnancy, Tran had been supported by the Alaska Native Birthworkers Community (ANBC), a coalition of Indigenous midwives, doulas, and advocates — collectively known as birthworkers — committed to improving maternal outcomes across the state.

At the heart of their work is a belief in the sovereignty of birth — the idea that Indigenous people have the right to birth on their own terms, in their own communities, and with their own cultural practices and ceremonies.

Their efforts come at a time when the stakes couldn’t be higher. Alaska Native mothers are 2.3 to 4 times more likely than White women to die during pregnancy or within one year of birth in a country with the worst maternal mortality rate among wealthy nations. That vulnerability is shaped by a long history of medical neglect, racism, and the removal of cultural birthing practices.

ANBC operates on what they call a “Three Sisters Model,” designed to create both systemic and immediate change. The First Sister offers support before, during, and after birth. The Second Sister trains birth helpers to serve Native families. The Third Sister focuses on policy to improve outcomes and experiences for Native mothers and babies.

“We’re reconnecting knowledge and ownership of birth, of caring for people in this phase of life,” said Margaret Gee’eedoydaalno Olin Hoffman David (Koyukon Athabascan), ANBC co-founder and midwife. “It isn’t something specialized like at a clinic or a hospital — it’s community.”

Since 2020, ANBC has had 400 requests for pregnancy services. They currently serve 100 families a year for child preparation retreats. As of April 11, 2025, the group had 36 active requests from expecting mothers.

For Tran, the support came at a crucial time. Throughout the nine months of her pregnancy, she held on to one hope.

“I wanted to survive the birth,” she said. “And have a healthy baby.”

First Sister: Direct Support

Tran grew up in Anchorage. As a child, she would visit her Yupik relatives in Aniak, a remote village in southwest Alaska with a population of 494. She remembers watching the Slavic — a Russian practice of caroling from house to house while spinning a large ornamental star — and eating Alaska Native foods like dried fish, seal oil, pickled salmon, and moose stew.

“I loved it,” she said. “It was always really special.”

She grew up hearing the birth stories of her mother and grandmother, whose experiences she describes as medical abuse and neglect — her mother being left alone to give birth in the hallway of a hospital. When Tran discovered she was pregnant in the summer of 2022, her excitement was quickly followed by fear.

“There was a lot of fear that I would go through that same treatment,” Tran said. “It was only 30 years ago when those things happened. That’s scary.”

And for some Alaska Native families, stories like that are still unfolding today.

While birth is considered one of life’s most sacred ceremonies in Native cultures, genocide and forced assimilation driven by the federal government’s cruel campaign to “kill the Indian, save the man” took birth out from the center of the community and into environments historically hostile to Native people.

Besides facing fears passed down from generational trauma — fears of facing outright mistreatment from providers or not being taken seriously — there was pregnancy itself.

“I didn’t realize how scary pregnancy is,” Tran said. “Not just what it does to your body, but the potential of having a complicated pregnancy, of things like fetal demise that happens out of nowhere.”

Tran connected with ANBC through the Alaska Native Medical Center, a healthcare system owned and operated by the Alaska Native Tribal Health Consortium and the Southcentral Foundation.

During her second trimester, Tran attended an ANBC group for expecting families, held on the ANMC campus. She and about 20 other pregnant Alaska Native women sat in a circle, their feet steeped in warm baths infused with cedar, rose and epsom salt. The birth workers led them through different birthing positions, and walked them through what would happen to their bodies during birth. She was connected with their doulas, who would be on call when it came time for her baby to come.

The hospital “goes above and beyond, they really work with us,” ANBC Co-Founder Abra Nungasuk Patkotak (Iñupiaq) told Native News Online. Around 1,600 babies are born at ANMC each year— half to mothers living in Anchorage, like Tran — the other half born to women whose pregnancies are deemed high risk. These expectant mothers travel to the hospital from their homelands in the state’s most remote regions, where roads and infrastructure are sparse.

Most mothers are alone for that time, as Medicaid coverage for travel and housing costs is limited to the birthing person, unless they are a minor, meaning partners, other children, or support people are often left behind.

At eight months pregnant, Alaska Native women living in villages leave their families and communities to fly into Anchorage, staying in patient housing for up to a month before giving birth. Most spend the final weeks of pregnancy in isolation, without partners, family, or community.

The process has been in practice since the late 1960s and aims to achieve safe birth outcomes for Alaska Native people living in extremely rural regions with little to no healthcare infrastructure or birthing resources, referred to as maternal health deserts.

The policy is rooted in a colonial logic that equates institutional control with safety — even when it requires severing cultural ties and displacing mothers from the support of their communities.

Patkotak told Native News Online that it isn’t unheard of for women to go into labor during travel, sometimes giving birth as soon as they arrive at ANMC.

“Imagine being in labor by yourself,” she said. “And you’re not just on a long plane ride, but you might have multiple plane rides away from your home.”

For Alaska Native families in these regions, women disappear from their communities and families at eight months pregnant, reemerging a month later with a newborn. It removes birth from community — a cultural event rich with the ceremony of welcoming a new life. A study by the University of Alaska Anchorage found that the stress of that travel is associated with preterm births, which can lead to breathing difficulties, heart problems and long-term complications.

Patkotak said that the standards for whose pregnancy is high-risk and merits travel and who can stay in their community are inconsistent.

“It’s really arbitrary. It’s just up to the provider,” Patkotak said. “There’s not really a set policy, and sometimes it doesn’t make any sense.”

David agrees. She recalls a pivotal moment when she heard an Inuit midwife speak at the Indigenous Congress of Midwifery in Toronto in 2017.

“It was a lightbulb moment,” she said. “Birthing away from our land and not in our language and away from our family and community is more of a risk than not having (healthcare) access … providing that care at home, in relationship, in our language, in our culture, is going to help keep pregnancies healthier.”

Doulas — often referred to as birth workers or birth helpers — provide non-medical support to pregnant people before, during, and after childbirth. Their presence and the emotional care they provide are reflective of a role that has existed in Indigenous communities for generations: Aunties.

Doulas are not an arbitrary support person. Studies show that pregnancies involving doulas are two times less likely to have complications for both mother and baby; four times less likely to have a low birth-weight, and are more likely to initiate breastfeeding.

While nearly half of all state Medicaid programs reimburse for doula care, Alaska does not.

Midwives, on the other hand, are licensed medical professionals who provide comprehensive prenatal care and deliver babies. Though midwives have attended births since time immemorial, as birth was medicalized in the 20th century, 10 states outlawed midwifery altogether. In others, training opportunities diminished as licensure requirements grew more complex and less accessible. As physicians' roles in birth were elevated, traditional practices at the center of Native communities were discredited. By the time the Indian Health Service was created in the 1950s, the government encouraged Native women to give birth at IHS hospitals on reservations. The ceremony and community of birth faded, and maternal mortality rates for Native women and their babies climbed.

Indigenous midwives are the intersection of medical care and ancestral knowledge. While ANMC has midwives available for pregnant families who request them, David is the only Alaska Native midwife in the healthcare system.

Doulas and midwives are experiencing a resurgence across the U.S. and Canada, driven by Native birth workers reclaiming practices lost under colonialism.

At 28 weeks, Tran’s baby was diagnosed with fetal growth restriction, meaning its weight was below the 10th percentile. While the baby’s vital signs were normal, it was scary.

As her pregnancy progressed, she used a pinard horn, a type of stethoscope used to listen to a fetal heartbeat. Every day, she would press it against her stomach to search for her baby’s heartbeat, fluttering rapidly like hummingbird wings behind the steady drumming of her own heart.

“I would have a wave of relief, because I knew that he was still alive,” she said. “It was very soothing. So it gave me peace of mind that everything would be OK.”

Birthing Experience

It had been several hours after Tran and Chris arrived at the ANMC birthing unit before medical staff told her that her labor wasn’t progressing fast enough. It was time to stimulate contractions with Pitocin, a synthetic form of oxytocin that induces labor.

She hadn’t called her ANBC doula yet. Things had been going well, if uneventful, and she wanted the on-call doula to be available to another birthing woman who may need them.

As the Pitocin dose gradually increased, running through an IV into her arm, so did the pain from her contractions, which she described as a deep burning sensation blossoming from her center, seizing her body as she clenched her teeth and took long, deep breaths.

“At that point, I said I wanted an epidural; the pain was too much.”

Tran was hoping the epidural would bring relief. Instead, after several failed attempts at inserting the needle, it brought panic.

“I let them know before I had even checked in that I am a sexual assault survivor, and to please let me know before doing anything, like just give me a heads up,” she said. “The last time (the anesthesiologist) tried to put the needle in, she just stuck me without any warning.”

As the needle entered her spine, she had a contraction that caused her body to jolt. That’s when she felt blood pouring from her back, and she began to cry. Her husband called for the doula.

Helena Benozaadleyo Jacobs (Koyukon Athabascan) was the doula on call that night. She arrived at the hospital within minutes of the call, and, as Tran put it, everything changed.

“She brought me water and got Chris a fold-down cot to rest in instead of the reclining chair in the room. She brought me bone broth, calming music, and a smudge,” Tran said.

As her labor progressed, Jacobs brought Tran a sense of calm and guided her body through the process, helped her change positions when needed, and acted as a cheering squad.

Jacobs describes her role as a doula as almost a “blank canvas.”

“I tell families that I am showing up as the blank canvas for them to fill in,” she said. “It’s really my job to be super attentive, to understand and interpret what those needs are, because often they’re communicated nonverbally… a little scrunch in their nose or a furrow in their eyebrow. My job is to be a continuous presence to offer love, encouragement, compassion, and nonjudgmental care.”

After nearly 24 hours of labor, Tran gave birth to a 5-lb baby boy.

Second Sisters: Training Birth Workers

David distinctly remembers the first time she attended the birth of another Koyukon family.

“It was somebody I knew, and I just happened to be there that day that she was having her baby,” she said. “I was so emotional because I was like, when was the last time a Koyukon midwife caught a Koyukon baby?”

For Jacobs, who naturally gravitated toward caretaking, attending births felt like “reintroducing this beautiful, natural ceremony that for generations, our families witnessed.”

Katrina Leary (Yup'ik and Athabaskan) became a doula for ANBC after the birth workers supported her when she welcomed her daughter in 2021. She later attended ANBC’s certified childbirth educator workshop, learning traditional birthing practices, labor and birth, and postpartum care.

Now, Leary often attends the births of the women flown into Anchorage from their remote communities, who, aside from medical staff, would be giving birth alone.

“So many people have to evacuate their home communities to give birth, then they're also the only Indigenous person in the birthing room,” she said. “I love sitting and getting to know somebody and hearing their story and building that relationship and making them feel safe and feel heard and feel cared for.”

For Leary, who is originally from Bethel, those relationships can run deeper. Last fall, she attended the birth of another young woman from Bethel, who asked her to cut the baby's umbilical cord.

“Her parents came in, and I was chatting with her dad, who asked me where I was from. As I was telling him about my family, he said, ‘Your grandma raised me for a while.’ It was a really impactful moment for me."

Third Sisters: Policy Change

David said that beyond working directly with families and training birthworkers, the group wants to see policy changes that honor the sovereignty of birth.

In recent years, Native birth workers have been increasingly working together on national and global scales to advance policies that recognize midwives and doulas and affirm their sovereign rights to cultural birth practices.

“We want Medicaid to cover support for birthing people to come with them,” she said. “We would love for this level of birthwork [doulas] to be reimbursable. The only option for birthing is through the hospital, and we would like direct-entry midwives to be acknowledged in the tribal health system, so people could give birth wherever they want to.”

While ANBC is growing its policy platform, David sits on the advisory council of Indigenous Birth, a non-profit organization that advocates at the national level for Indigenous birth rights. Patkotak is a core committee member with the State of Alaska Maternal Child Death Review, and she regularly attends conferences both as an individual and a representative of ANBC, including the Global Council of Indigenous Midwives.

Last year, she represented the United States in a first-of-its-kind cohort of traditional birth workers from across the Americas at the 23rd session of the United Nations Permanent Forum on Indigenous Issues in New York City.

‘We heal like the generations’

The Tran family named their son Uksumi, which means "wintertime" in Yup'ik.  He shares his Native name, Aketuq,  with his great-great-grandfather, whose given name was Timothy Kameroff Sr. Tran explained that, in Yup'ik culture, namesakes are considered a form of reincarnation, someone’s spirit being imbued into the younger person who carries their name. Her great-grandfather was the last of her family to know yuarun— a form of traditional Yup'ik singing. The elder did not pass the knowledge down to his children, for fear they would be abused in the boarding school system for practicing their culture.

“Thousands of years of these songs, they died with him,” she said.

But with Uksumi, that silence is breaking.

Language, like birth, is a sacred vessel for culture. And for Tran, restoring one helps reclaim the other.

Now two years old, Uksumi attends a Yup'ik immersion program through the Cook Inlet Early Learning Center, making him the first person in three generations to be immersed in the language.

For Tran, nurturing Uksumi’s connection to their Yup'ik culture is reciprocal.

“It’s like full circle,” she said. “I’m proud of everything, because each piece is integral to being Yup'ik. It was missing for so long, and it’s finally coming together again, and it’s him.”

For the birthworkers at ANBC, Tran and Oksana represent the heart of the organization’s mission.

“When the pregnant person is well taken care of, that sets up the best life for the baby in terms of health,” David said. “How we take care of ourselves, especially during rites of passage, affects our lifelong health.

“When we heal ourselves, we heal like the generations that came before us and those yet to come.”