Letter from the Oversight Committee Chair
Personal commitment. Team Work. Perseverance.
Success at great endeavors, like winning Olympic gold, takes tremendous effort over a long period of time. Long hours of training require personal commitment, yet commitment alone is not sufficient without a team of coaches, the support of family and friends, and financial backing. While these elements help to push an Olympian toward gold, it is the ability to move forward in the face of adversity that keeps you in the race.
Over the course of the last 10 years, we have worked together to remedy the problems that contribute to morbidity and mortality in mothers and babies of Tennessee. Each year we implement new projects to combat the root causes of maternal and infant mortality, and each year we have grown in our ability to work more effectively as a team to raise the quality of care for our patients. Each of us has committed our valuable time because of our own personal commitment to safe deliveries for all.
Our administrative team has grown thanks to the backing of the Tennessee Department of Health and the CDC. Funding has enabled us to reach more of you where you live rather than over the internet and enabled more training that puts the tools of improvement into your hands. I’m so proud of the outreach that we have been able to achieve this year. We’ve heard from you directly just how valuable it has been to your own QI team. Thanks to you:
- 35 hospitals were involved in TIPQC projects with 13 more receiving resources and education this year, including new hospitals like Bradley Medical Center.
- Help us encourage more birthing hospitals in Tennessee to join.
- 32 Community Organizations, likely one in your town, have joined TIPQC’s Community Resource Council this year, including Tennessee Voices and the Governor’s Early Literacy Foundation.
- Let us know how we can expand resources in your community.
- Of the 672 infants enrolled in the NICU Chronic Lung Disease project, we projected that 17 more infants survived that wouldn’t have without your work.
- Join our next NICU project: Reduction of Hospital Acquired Infection (HAI).
- Join our next Infant project: Born to Thrive: The Care of the Late Preterm Infant (LPI).
- 6,405 (pregnant) women were screened for cardiovascular disease with 63 positive screenings referred to their local MFM or the Maternal Cardiac Network.
- Join us in our next maternal project: Improving the Care and Outcomes of Obstetrical Hemorrhage
And yet, we are reminded by the valuable data provided from Infant and Maternal Mortality Reviews through the Tennessee Department of Health that even in the face of improvement in your town or county, there is more work to be done. Each project identifies aspects of treatment, or care, or access in need of improvement … elevating the care of mothers and babies across Tennessee.
The road to gold at the Olympics is very much like the path to success with TIPQC. Which is why we are grateful for your personal commitment, for your ideas and feedback on how we can coach you (and more hospitals) more effectively, and for your perseverance as we continue to improve together. You can’t do a triple axel if you haven’t mastered a single axel, and we are dedicated to helping you improve so that we all take that Olympic leap and improve … together.
With deep admiration for the work you do with us,
Susan Guttentag, MD
Principle Investigator
SUSAN GUTTENTAG, MD
TIPQC Operations Staff
The TIPQC Infant and Maternal Medical Directors as well as the Quality Improvement (QI) Nursing Specialists provide expertise, passion, and knowledge to all the work of TIPQC. The core team also includes QI, project, and data management expertise.
August 2025- TIPQC’s Annual Leadership Retreat
48 Hospitals
involved in TIPQC Improvement Projects or receiving resources & education from TIPQC.
6,405 Women
Had a Cardiovascular Disease Screening completed in the Cardiac Project.
672 infants
Enrolled in the CLD project with 0 deaths!
9 Patient & Family Partners
Trained through Momma’s Voices to support hospital team’s engagement of Patient & Family Partners.
52 Certified Breastfeeding Specialists
Trained through Lactation Education Resources (LER).
50 Blood Pressure Cuff Kits
Distributed for high risk pregnant and postpartum patients, totaling 4,711 kits among 34 hospitals disseminated over the last five years.
17 infants
Lived due to the CLD project, based on 3 years baseline data.
1000 badge buddies & 350 posters
Distributed to teams in support of the Cardiac Conditions in OB Care project.
94 Birth Workers
Trained in Spinning Babies®, totaling 433 individuals.
5 Doula Trainings
Across the state with 42 individuals from 31 organizations attending, in conjunction with the Cardiac Conditions in OB Care Project, resulting in 92 individuals receiving training the past two years.
5 SUD & OEN Trainings
Hosted throughout the state. Attendees received resource binders filled with patient & provider resources related to comprehensive care for pregnant women with SUD and opioid exposed newborns.
35 Hospitals
Visited during site visits with the TIPQC team to discuss SMM, data, and areas for collaboration.
4 “Minute for Improvement”
Short videos developed & recorded in TIPQC’s “Minute for Improvement” series.
32 Community Organizations
Participating in TIPQC’s Community Resource Council.
34,573 Downloads
Of the TIPQC Healthy Mom Healthy Baby Tennessee Podcast.
15,229 Unique Listeners
of the TIPQC Healthy Mom Healthy Baby Tennessee Podcast.
35 Physicians
Physicians earned 650 American Board of Pediatrics Maintenance of Certification (MOC) Credits and ACOG MSPP Part IV Credit.
132 Hours
of Continuing Education provided through CME.
4 Regional Simulations
Conducted throughout the state on respectful conversations training 78 different individuals.
103 Attendees
Trained in TIPQC’s Comprehensive Care for Pregnant Women with SUD & Caring for Opioid Exposed Newborns training modules.
Tennessee Tiniest Babies: The Reduction in Chronic Lung Disease (CLD) project
As part of the Tennessee Tiniest Babies Bundle, The Reduction in Chronic Lung Disease (CLD) Project for infants born less than or equal to 29.6 weeks gestational age went into sustainment after more than a year of work in 10 of the Level 3 & 4 NICUs on June 30, 2025. All hospitals were able to maintain or decrease Grade 3 CLD. Participating hospitals also reported no death due to CLD during the project. With 672 infants across the state in this project, this is the equivalent of 17 premature babies who survived that would not have the previous year. Congratulations to all the hospitals who improved care to reduce CLD.
“We definitely decreased (CLD) and I am very happy with the project! Our MDs and NNPs have had numerous discussions both in quarterly meetings and just informally talking about the project and the nurses on our team have done a lot of education. I am keeping up with the numbers for sustainment.” Carolyn Wong, NNP-NE, Pediatrix Medical Group, Methodist LeBonheur Germantown Hospital
“I love being part of TIPQC. It makes me accountable for what should be done in our small NICU. The support of everyone in TIPQC is amazing.” Jenda Arawiran, MD, Parkridge East Hospital
“It has truly been an honor to work on this project and to witness the incredible progress we’ve made together. ‘Perfection is not the goal — progress is.’ — Unknown” Marla Kirk MBA, BS, RRT, Director, Respiratory Therapy, Methodist Germantown Hospital & TIPQC State Project Leader
“Each TIPQC project I’ve been part of has been so energizing because we get the opportunity each time to not only build a better world for our patients and their families but also create a community with each other- a group of like-minded people working to make Tennessee healthier!” Malinda Harris, MD, East Tennessee Children’s Hospital, TIPQC State Leader
IRTH
Thanks to a grant from the CDC Foundation, Irth was able to begin working in the Memphis area addressing the care and outcomes for black and brown mommas. Irth is a review and rating platform where partners, doulas, nurses, & midwives can leave and find reviews for obstetricians, hospitals, and postpartum care. Irth uses the power of the patient voice to work with hospitals, payors, providers, and government agencies to encourage accountability and transparency to improve care. Irth hopes to expand its services throughout the state in coming years.
Cardiac Conditions in Obstetric Care (CCOC) Project
In conjunction with the Alliance for Innovation on Maternal Health (AIM), the TIPQC faculty adapted the Cardiac Conditions in Obstetrical Care (CCOC) patient safety bundle with pilots starting in the Fall of 2024, statewide kickoff in October 2024, and ongoing work throughout 2025. 14 teams have a goal to implement a cardiac screening and appropriate referrals for 90% of all pregnant and postpartum women.
During February, for heart month, TIPQC held two webinars focusing on maternal cardiac care. The Heart of a Mother series focused on cardiac physiology & screening and the need for lifelong care.
TIPQC traveled the state for a second year, to the five perinatal regions, hosting Doula Resource Trainings to support this project. Education was provided surrounding preeclampsia, hypertension, and trauma informed care. Over 40 doulas joined us from across the state.
“By prioritizing the management of cardiac conditions during obstetrical care, we are not only enhancing maternal health outcomes but also setting a new standard for patient-centered care. This initiative helps to bridge gaps in clinical practice, foster interdisciplinary collaboration, and empower healthcare providers with tools and knowledge to address complex cardiac challenges in pregnancy.” Lynlee Wolfe, MD, UTMCK
“From the beginning we knew this project would not be easy and would take work to get off the ground. Through collaboration from TIPQC Leadership and our wonderful hospital teams 6,405 cardiovascular disease screenings have been completed. Over half of the teams are Level I and II Maternal Care Centers so implementing this screening has the potential to truly save lives and provide the appropriate care for mothers across Tennessee“ Tanika Edwards, BSN, RN, TIPQC
“I wanted to share how much we appreciate the support and encouragement you’ve shown us from the very beginning of the TIPQC maternal cardiovascular screening initiative. This work is important to our team, and we truly care about serving our patients and community in Cleveland. We believe much of our success reflects the strong support we’ve received from leadership, including the CNO and CQO here at BMC, along with our physician partners and director leadership, and we’re thankful to be part of such a collaborative team. Again, thank you for the support, compliments, on-site visit and instructions which have contributed to our success in the project.” Jamie Tant, RN, Women’s Services Director, Bradley Medical Center
Tanika Edwards, Dr. Hannah Dudney from TDH, and Brenda Barker learning from our Georgia colleagues at Hope For Georgia’s Moms, along with Mary Lou Wilson, the PI for this work.
In Sustainment
Tennessee’s Tiniest Babies: Reduction in Intraventricular Hemorrhage (IVH)
With all 12 teams remaining in sustainment and collecting data, sustainment huddles and coaching calls have been coordinated with this entire bundle. IVH rates are continuing to be tracked through SimpleQI in ongoing projects.
PVD
TIPQC continues to support the work of all 35 teams who participated in the Promotion of Safe Vaginal Delivery (PVD) Quality Improvement Project which concluded in September 2024. With ongoing sustainment and improvement work, many of our hospitals remain at or below 23.6% for their NTSV C-section rates, the national standard. In support of the hospital teams, TIPQC, along with TDH Maternal Health Innovation Program (MHI), hosted three Spinning Babies Classes. For more information on these classes, see the “2025 Educational Opportunities” section.
“Although the PVD project formally transitioned into sustainment prior to this past year, hospital teams across the state have continued to demonstrate unwavering commitment to reducing primary C-section delivery rates. Their sustained engagement and data-driven efforts to meet and exceed national benchmarks reflect a deep culture of quality improvement. Ongoing successes in this work are especially meaningful given the complexity of our patient populations, and they highlight the strength, collaboration, and resilience of Tennessee’s perinatal care teams.” Danielle Tate, MD, MBA, TIPQC State Project Leader
“Through the TIPQC Promotion of Vaginal Delivery initiative, Regional One moved an already strong C-section rate into the excellent range—and, more importantly, has sustained that performance over time.” Kerri Brackney, MD, Regional One Health
TeamBirth
All three TeamBirth pilot teams joined the Best for ALL Learning Collaborative to support their sustainment efforts. TeamBirth and Best for ALL are closely aligned, with their mutual emphasis on providing respectful, patient centered care to each and every patient.
TIPQC also congratulates Hardin Medical Center for achieving national TeamBirth recognition in August 2025. TeamBirth recognition reflects more than a process change. It demonstrates a commitment to sustaining a culture where patients are listened to, their preferences are respected, and care teams remain accountable. By aligning communication and decision-making in high-acuity maternity settings, these hospitals are setting a national standard for safer, more respectful care.
2025 Educational Opportunities
Severe Maternal Morbidities (SMM) Webinars
TIPQC held quarterly webinars on SMM case reviews with providers from across the state. During these webinars providers review cases and the SMM indicators that were present. Patient treatment and outcomes based on the care received are reviewed.
“I liked being able to look at the case review events and hearing the educational process and what could’ve been done differently.” Quality Outcomes Specialist
“The topics are things we all know about but were put together and presented in a way that will change my practice. I’ve been doing this for 28 years and I am constantly amazed at what we are learning and discovering about women’s health, pregnancy, and the lasting impact.” Nurse Educator
Substance Use Disorder Screening & Referral Training
Over the Summer of 2025, TIPQC sponsored regional trainings on screening, referral, and treating pregnant women with substance use disorder, caring for infants with opioid exposure, and recognizing and referring pregnant and postpartum patients with mental health concerns. These 4-hour trainings were led by Drs. Anna Morad, Jessica Young and Julia Wood. Throughout the five training courses, TIPQC trained 97 individuals from 52 different organizations or hospitals throughout the state.
“Really enjoyed spending time with you. The talk was wonderful!” Maggie Dibble, BSN, RNC-NIC, NICU Nurse Manager, St. Francis Hospital
Training Module: Comprehensive Care of Pregnant Women with SUD & Opioid Exposed Newborns
In 2025, TIPQC filmed three videos with Dr. Anna Morad, Dr. Julia Wood, and Dr Jessica Young. These videos focus on Care of the Newborn with Opioid Exposure, Postpartum Mental Health and Suicide Screening, Obstetric Care for Pregnant Women with Substance Use Disorder. These films accompany the content in the live regional sessions and are a wonderful resource and already have over 100 views.
SMFM Hypertension Collaborative
Fourteen TN Hospitals are participating in the Hypertension in Pregnancy Change Package Collaboration through the Society of Maternal Fetal Medicine. Work began in the Fall of 2025 and will continue through the Summer of 2026.
“We are absolutely THRILLED that 14 hospitals have expressed interest in participating in our learning collaborative! Thank you again for this amazing connection. We are so excited to have Tennessee be a part of our hypertension learning collaborative!” Taylor E. Streeter, MPH, Manager, Public Health Initiatives, Society for Maternal-Fetal Medicine
Grand Rounds: Making a Difference in Opioid Use Disorder in Pregnancy: From Screening to Treatment
TIPQC’s State Project Leader, Dr. Jessica Young, led a series of Grand Rounds throughout the state to train residents in best practices for treating pregnant patients with substance use disorder.
Respectful Care Simulations
During the summer of 2025, TIPQC sponsored a regional series of simulation trainings on respectful care in the obstetric and neonatal setting. Led by Bonnie Miller, RN, MSN, Danielle Tate, MD, MBA, and Patti Scott, DNP, APN, NNP-BC, C-NPT, the morning started out with a didactic session on Trauma Informed Care, Adverse Childhood Events (ACES), and the importance of language and compassion in navigating these complex situations. Attendees then transitioned into simulation groups where they learned how to navigate and apply the skills from the morning with specific case scenarios. Over the course of the four Regional Sims, 78 individuals from 35 different hospitals and community organizations were trained in Respectful Care.
“…I have to discuss sensitive subjects often. This will help me use different languages and be more supportive of my Mamas.” Nurse Attendee
Lactation Workforce Training
52 individuals have successfully completed the Certified Breastfeeding Specialist (CBS) course through Lactation Education Resources. In addition, TIPQC was able to secure the 2-hour Assuring BF Success course for all hospital staff desiring this training at no charge. Both of these trainings bring us closer to ensuring that every breastfeeding parent has access to the care and encouragement needed to be successful in their journey.
“I am a proud graduate of the CBS training granted to me by TIPQC earlier in the year. It even ignited my drive to go for my IBCLC and I tested for it in September. I wanted to thank you for the opportunity! I work as a Lactation Nurse, Postpartum Doula, and Night Nurse currently and am always looking for ways to further my education and make the world a better place one mama and baby at a time!” Kaitlyn Sackett
Quality Improvement Bootcamps
TIPQC hosted two Quality Improvement bootcamps in 2025. The first bootcamp was held in May, and the second QI Bootcamp was held in September in Nashville.
During these bootcamps, led by Eva Dye, DNP and Dupree Hatch, MD, attendees learned a general overview of quality improvement, including general QI tools, run charts, and strategies. All attendees left with a baseline knowledge of quality improvement and how to apply it to their respective systems.
Spinning Babies® Training
TIPQC was delighted to offer 3 Spinning Babies courses to TN hospital teams, doulas and birth workers in September 2025, sponsored by the Tennessee Department of Health, Maternal Health Innovation grant. During the 8 hour, in-person workshops, 94 attendees learned the different balancing techniques, labor positioning techniques, and physiology to address stalls in labor in order to further support TN moms and babies in labor & delivery.
Doula Resource Trainings
Five (5) in-service trainings were held across the state to support over 40 doulas with education provided on Hypertension, Preeclampsia, and Trauma Informed Care with Drs. Connie Graves, Lynlee Wolfe, and Danielle Tate. TIPQC was able to provide continuing education credits from International Childbirth Education Association (ICEA).
I wanted to reach out and thank you and your staff for including me for this opportunity. Providing quality care and education to those who need it is such a passion of mine as a doula. I was also glad to be a part of the Educational Training today as well with Dr. Connie- I was happy to receive this information. Just wanted to again express that I am glad you all are putting on trainings and getting the word out there regarding perinatal care. I am grateful that there are plentiful resources available to me and my peers. Hope to see you all in the future for other opportunities and events.” Kirstyn George, Doula
TIPQC’s Minute for Improvement
In 2025, TIPQC wrote, filmed, produced and edited four short video clips in the “Minute for Improvement” series. These clips are designed for healthcare workers, patients, and the community. The topics include respectful screening for substance use disorder, using respectful language in patient care, educating patients on post birth warning signs, and the benefits of a vaginal delivery.
Teams are encouraged to download the video and share with team members, patients and other stakeholders. They were also provided with various resources to support this implementation.
Community Involvement
TIPQC partners with many dynamic local, state, and national organizations and communities to improve the pregnancy and birthing outcomes for all our Tennessee families. Thank you to our collaborators!
- Alliance for Innovation on Maternal Health (AIM)
- American Academy of Pediatrics (AAP)
- American Board of Pediatrics (ABP) Maintenance of Certification (MOC)
- American College of Obstetrics & Gynecology (ACOG MSSP, TN ACOG & District VII ACOG)
- Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN)
- BlueCare Tennessee
- National Network of Perinatal Quality Collaboratives (NNPQC)
- Postpartum Support International (PSI)
- Spinning Babies®
- Tennessee American Academy of Pediatrics (TNAPP)
- Tennessee Department of Health
- Tennessee Hospital Association
- UnitedHealthcare Community Plan
- Vermont Oxford Network (VON)
- Wellpoint
TIPQC’s Community Resource Council
Founded in the Summer of 2025, the TIPQC Community Resource Council aims to gather the perspective and insight of community organizations across the state and incorporate their voices in upcoming Quality Improvement projects. In 2025, TIPQC held four Regional Community Resource Council meetings in Memphis, Nashville, Knoxville and Chattanooga. With 32 official members, TIPQC is excited to continue to network with organizations throughout the state who are working to improve care for moms, babies and families in TN.
National & Statewide Data and Reports
TIPQC is committed to improving outcomes for the pre-pregnancy, pregnancy, and postpartum women in Tennessee through collaborative state and national partnerships.
According to the March of Dimes, Tennessee continues to have poor outcomes for our moms and babies receiving a D on the Report Card.
According to the Maternal Vulnerability Index (MVI), pregnant women in Tennessee have a very high vulnerability to poor outcomes and are most vulnerable due to mental health and substance use. The MVI is a tool used to understand where pregnant women in each state are more likely to have poor outcomes, including preterm birth and maternal death, due to clinical and other risk factors. (Surgo Health, Maternal Vulnerability Index, 2025.)
TDH Reports
The Tennessee Department of Health recently released the following reports: