Understanding
Severe Maternal Morbidity
Intro
Severe Maternal Morbidity (SMM) refers to health-impacting and life-threatening complications of pregnancy, occurring during hospitalizations for childbirth. These complications carry significant short- and long-term physical, psychological, social, and financial consequences.
Tennessee Department of Health (TDH) 2025 SMM Report Key Findings:
- Between 2018 and 2022, there were 189 pregnancy-related deaths and 2,795 deliveries with one or more SMM. This means that for every death, 15 deliveries experienced SMM events.
- Between 2018 and 2021, the SMM rate (the number of deliveries with one or more SMM indicators per 10,000 deliveries) increased from 71 to 87 – a 23% increase likely driven by COVID-19. However, there was a slight decrease to 81 per 10,000 deliveries in 2022.
- Hemorrhagic diagnoses and procedures were the most common category of SMM, accounting for one-third of morbidities. Disseminated intravascular coagulation was the most common diagnosis[1]based indicator, and hysterectomy was the most common procedure-based indicator. These were also the first and second most common hemorrhagic indicators, respectively.
- Non-Hispanic Black women in Tennessee experienced the highest burden of severe maternal morbidity with an SMM rate of 112/10,000, which was over 1.5 times as high as that among Hispanic and non-Hispanic White women. Severe maternal morbidity rates increased with increasing maternal age, with the rate among women 40 years and older almost three times as high as among women less than 25 years of age.
- Severe maternal morbidity rates varied across Tennessee health department regions, with the highest rates observed among women living in the East Region and the Shelby, Knox and Madison metro counties. Women living in the Upper Cumberland Region had the lowest rate
SMM Site Visits
Are you interested in diving into your hospital’s SMM rate? TIPQC is offering site visits to each to hospital in TN. During these in-person visits, TIPQC staff will review your data, share best practices for conducting case reviews, and walk you through how to access your data in the AIM Data Center.

SMM Webinar #3, September 2025
In this video we are joined by UTMCK. Megan Young, MPH shares on the development of the major OB committee and Drs. Tripp Nelson and Lynlee Wolfe review three cases with SMM indicators.
SMM Webinar #2, May 2025
In this video Dr. Tate and Isaac Yi, MA cover the newly released TDH SMM report and SMM case reviews.
TIPQC is actively recruiting devoted health care professionals, community leaders and patient and family partners to further our mission of improving health outcomes for mothers and babies in Tennessee.