Brief Overview of State MMR or PAMR

Montana’s Maternal Mortality Review legislation passed in 2013 and was folded into the existing fetal, infant and child mortality review structure. The program is called FICMMR (Fetal, Infant, Child & Maternal Mortality Review).The mission of the maternal mortality program is to reduce preventable deaths. When the legislation passed, a statewide, Maternal Mortality Review Advisory Group was formed to identify the structure/processes for the reviews. Currently, the advisory group serves in an oversight capacity and as a resource for the county teams who conduct the actual reviews. The county teams are volunteer and multidisciplinary. When a maternal death is on the agenda, the FICMMR law requires either an Obstetrician, or a Family Practice Physician, or a Physician's Assistant who has direct OB responsibilities to participate in the review. All pregnancy–associated and pregnancy-related deaths are reviewed. In 2016, Montana had 12,274 live births and seven maternal deaths.

Kari Tutwiler
State Child & Maternal Mortality Coordinator
Montana Public Health & Human Services
This individual fills the role of: 
MMR/PAMR Administrative Coordinator
Ann Buss, Supervisor Maternal & Child Health
This individual fills the role of: 
State Agency Leadership (e.g. MCH Director, Chief Medical Examiner)
Scope of Cases Reviewed
  • All pregnancy-associated deaths (All deaths of women while pregnant or within one year of the end of pregnancy, due to any cause)
  • All deaths during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy, and not intentional or unintentional injury
Location of Deaths Reviewed by Committee
  • State Residents (or City/County Residents if local review)
Individuals, Disciplines, and Organizations Represented on Review
  • Perinatal Nursing
  • Psychiatry/Mental Health Provider
  • Public Health Nursing
  • Midwifery
  • Nursing
  • Pathology
  • Obstetrics and Gynecology
  • Social Work
  • Tribal Organizations
  • Clergy/Faith Community
  • Child Death Review Staff
  • Emergency Response
  • Hospitals/Hospital Association
  • Law Enforcement
  • Family Medicine
  • Fetal and Infant Mortality Review Program Staff


Pregnancy Associated Deaths in Montana, 2003-2009

Montana Maternal Mortality Workgroup
Year of publication or last update: 
Pregnancy associated deaths are the most inclusive definition of a maternal deaths. Deaths from motor vehicle accidents were four-times higher and deaths from other unintentional injuries were twice as high among pregnancy-associated deaths as among deaths to women in the same age range who were not and had not recently been pregnant.

Pregnancy-Associated Mortality: Assessing the Effectiveness of the Pregnancy Check Box and Vital Records Linkage using Montana Death Certificate, 2004-2013

Montana Maternal Mortality Workgroup
Year of publication or last update: 
Pregnancy-associated deaths are better ascertained by using record linkage between the death certificate and the corresponding live-birth or fetal death certificate. From 2004-2013, 23 additional pregnancy-associated deaths were determined by using record linkage compared to those ascertained by only using the death certificate.