For American Indian and Alaska Native (AI/AN) birthing people, the risk of pregnancy-related death is two to three times higher than that of white birthing people. In Alaska, the disparity is even greater; Alaska Native birthing people have the highest rates of pregnancy-associated mortality, at over five times higher than white birthing people. This case study from the University of Minnesota Rural Health Research Center examines the strengths and challenges for a hospital-based Tribal maternity unit located in Northwestern Alaska.