BIRP Notes for Perinatal Clients: Template + Examples (2026)
Overview
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Short answer: a BIRP note for a perinatal client (pregnancy and the first year after birth) has four parts. Behavior: the client’s report and presentation: mood, anxiety, sleep (separating baby-related waking from being unable to sleep when the baby sleeps), bonding, relationships, function and any thoughts of harm to self or the baby. Intervention: what you did, such as interpersonal psychotherapy (IPT) or CBT techniques, screening and safety assessment. Response: how the client responded, scores such as the EPDS, goal progress and your risk judgment. Plan: next steps, practice, coordination with the obstetric or pediatric team and when you will repeat measures.
Record the perinatal context every time: weeks pregnant or weeks since birth, feeding and sleep arrangements, who else is caring for the baby, and which clinician manages any medication. These details explain changes in symptoms and help the next reader understand the risk picture.
What to document in a BIRP note for perinatal clients
| Section | What to document | Example wording |
|---|---|---|
| Behavior | Weeks pregnant or postpartum; mood, sleep, bonding, relationships and function; thoughts of harm to self or the baby, asked directly | “11 weeks postpartum; low mood most days; sleeps when the baby sleeps; argued with partner twice about night feeds; denies thoughts of harming herself or the baby.” |
| Intervention | The approach and techniques used, screening and safety assessment | “IPT role-transition work; communication analysis of Tuesday’s argument; role-played a request to her partner; EPDS given.” |
| Response | In-session response, scores, goal progress and risk judgment | “Practiced the request twice; EPDS 14 (19 at intake), item 10 scored 0; acute risk judged low.” |
| Plan | Next focus, practice, coordination and repeat measures | “Make the request at a calm time this week; continue weekly IPT; EPDS every 2 weeks; coordinate with the obstetrician as agreed.” |
Safety. Ask directly about thoughts of suicide and of harming the baby, and record the answers. If a client reports suicidal thoughts, assess and record current thoughts, plan, intent, preparatory behavior, past attempts, access to means (including firearms and medications), protective factors, your risk formulation and the safety plan. Unwanted, distressing intrusive thoughts about harm coming to the baby are common in perinatal anxiety and OCD and are different from intent; record what the client describes and your assessment. Signs of postpartum psychosis, such as confusion, hallucinations, delusions or mania, are a psychiatric emergency: call 911 or go to the nearest emergency department now. Assess difficulty sleeping despite an opportunity to sleep in context; it does not by itself establish psychosis. Ask about a markedly reduced need for sleep with increased energy or other signs of mania. The National Maternal Mental Health Hotline (1-833-TLC-MAMA, call or text) is free and confidential, 24 hours a day. The 988 Suicide & Crisis Lifeline takes calls and texts at 988; for imminent danger, call 911 or go to the nearest emergency department.
How to Document BIRP Notes for Perinatal & Postpartum Clients
Behavior
Document observable client behaviors, actions, and presentation in session
When documenting the Behavior section for perinatal clients, focus on capturing client-reported emotional and physical symptoms, presenting concerns related to pregnancy or postpartum status, specific triggers impacting mood or anxiety, and observed mood or affect during the session.
- Client reports symptoms of prenatal or postpartum depression (e.g., sadness, fatigue).
- Client describes anxiety or intrusive thoughts related to pregnancy or infant care.
- Client identifies specific triggers such as hormonal changes, sleep disruption, or relationship stress.
- Observed affect consistent with mood congruent to perinatal stressors (e.g., tearfulness, irritability).
- Client expresses concerns about bonding or attachment with the fetus or newborn.
Intervention
Record specific therapeutic interventions and techniques used
In the Intervention section for perinatal clients, document the therapeutic techniques, clinical observations, and modalities used to address perinatal-specific mental health needs and support maternal-infant well-being.
- Utilized psychoeducation about hormonal influences on mood during pregnancy and postpartum.
- Applied mindfulness or relaxation techniques tailored to perinatal anxiety or stress.
- Conducted safety assessment regarding suicidal ideation or postpartum psychosis risk.
- Engaged client in cognitive-behavioral strategies focused on managing intrusive maternal thoughts.
- Provided support and resources for breastfeeding challenges or sleep management.
Response
Note the client's response to interventions and observable changes
The Response section should document the client’s reaction to interventions, progress toward treatment goals, clinical impressions regarding symptom changes, and any diagnostic considerations relevant to the perinatal period.
- Client demonstrates increased insight into mood fluctuations related to perinatal changes.
- Reported reduction in anxiety symptoms following use of relaxation strategies.
- Client shows ambivalence or resistance to discussing bonding with infant.
- Clinical impression notes persistence of depressive symptoms warranting continued monitoring.
- Client verbalizes understanding of safety plan and expresses decreased suicidal ideation.
Plan
Outline next steps, continued interventions, and session scheduling
In the Plan section for perinatal clients, outline next steps including treatment adjustments, assigned homework related to perinatal mental health, referrals for additional support, and scheduling of follow-up sessions.
- Schedule follow-up session to monitor mood changes in postpartum period.
- Assign journaling exercises focused on maternal-infant bonding experiences.
- Refer client to lactation consultant or perinatal support group as indicated.
- Modify treatment plan to incorporate trauma-informed care for birth-related stress.
- Coordinate care with obstetric provider regarding medication management concerns.
SOAP Notes for Perinatal Clients
Alternative format for documenting perinatal clients
DAP Notes for Perinatal Clients
Alternative format for documenting perinatal clients
Progress Notes for Perinatal Clients
Alternative format for documenting perinatal clients
SIRP Notes for Perinatal Clients
Alternative format for documenting perinatal clients
GIRP Notes for Perinatal Clients
Alternative format for documenting perinatal clients
PIE Notes for Perinatal Clients
Alternative format for documenting perinatal clients
Example BIRP note for a perinatal client (postpartum depression, IPT)
Fictional documentation example, not treatment guidance. Every detail is invented. Adapt it to the session you actually provided and your organization’s requirements.
Session details: Fictional adult client, 29, 11 weeks after the birth of her first child. Major depressive disorder, single episode, moderate, with peripartum onset (F32.1); symptoms began about 2 weeks after the birth. Session 5 of 12 of weekly interpersonal psychotherapy (IPT), problem area role transition (becoming a parent and leaving her job for parental leave), 50 minutes, by video. Not taking psychiatric medication; her obstetrician knows about the referral. Treatment-plan goals: (1) EPDS below 10; (2) ask her partner for specific help at least twice a week; (3) one activity outside the home with another adult each week.
Behavior: Client reports low mood most days and feeling “like I’ve lost who I was.” Bottle-feeding; partner does one night feed on weekends only. Says she can sleep when the baby sleeps but wakes 3 times a night for feeds. Argued with her partner twice about night feeds; both times she said nothing until she “exploded.” Went to a parent-and-baby group once (goal 3 met this week). Returns to work in 6 weeks and worries about managing both roles. Describes feeling close to the baby. Asked directly: denies thoughts of suicide or self-harm, now and since the last session, and any past attempts; denies thoughts or urges to harm the baby. No firearms in the home. Screened for postpartum psychosis warning signs: no confusion, hallucinations or unusual beliefs, and she sleeps between feeds. Appearance tidy; affect sad, brighter when describing the group; speech and thought process normal.
Intervention: IPT, middle phase: reviewed the link between mood and the week’s interpersonal events; explored what she misses about her old role (colleagues, feeling capable) and what the new role offers; communication analysis of Tuesday’s argument, identifying that she expected her partner to notice she needed help without asking; role-played a clear, specific request (“Can you take the 2 a.m. feed on Tuesday and Thursday?”) twice; discussed how to raise return-to-work plans with her partner. Administered the EPDS. Reviewed the safety plan.
Response: Client said, “I keep waiting for him to offer.” She made the request more clearly on the second role-play and said she felt “less guilty asking.” EPDS: 14 (19 at intake), item 10 scored 0; still in the range of probable depression, improving. Goal 1 not met; goal 2 not yet met (no direct requests this week); goal 3 met. Risk formulation: no current or past suicidal thoughts or attempts, no thoughts of harming the baby, no psychotic symptoms, no firearm access, supportive partner and mother, engaged in treatment; acute risk judged low. Reassess every session; postpartum risk can change quickly.
Plan: Continue weekly IPT; session 6 next week, continuing role-transition work and planning the return to work. Client chose to make one specific request to her partner at a calm time this week and note how it went. Attend the parent-and-baby group again. Repeat EPDS every 2 weeks. With her consent, send a brief update to her obstetrician; she can discuss medication options with the obstetrician if she wishes. If confusion, hallucinations, delusions or signs of mania appear, she or her partner will call 911 or go to the nearest emergency department. New difficulty sleeping despite an opportunity to sleep will prompt contact with her clinician for assessment; a markedly reduced need for sleep with increased energy or other signs of mania requires emergency evaluation. National Maternal Mental Health Hotline 1-833-TLC-MAMA reviewed. Client knows to call or text 988 in a crisis and to call 911 or go to the nearest emergency department for imminent danger.
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Tips for BIRP Notes for Perinatal & Postpartum Clients
Record weeks pregnant or postpartum
Write the perinatal timing in every note, such as “11 weeks postpartum” or “28 weeks pregnant,” so changes in symptoms can be read in context.
Separate sleep loss from insomnia
Note whether the client can sleep when the baby sleeps. Being unable to sleep even when there is a chance is a different and more concerning finding.
Ask about the baby directly
Record whether the client has thoughts of harming the baby and how she describes any intrusive thoughts, with your assessment of intent.
Track a perinatal measure
Repeat the EPDS at a set interval and record item 10 every time, along with the total.
Name the approach and the focus
Write the specific work, such as “IPT role transition, communication analysis,” so the skilled intervention is clear.
Note coordination
Record contact with the obstetric, midwifery or pediatric team, what was shared and the client’s consent, and who manages any medication.
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Further Reading
- SAMHSA — Provides resources and guidelines on behavioral health treatment and documentation relevant to perinatal and postpartum mental health.
- APA Documentation Guidelines — Offers detailed clinical documentation standards that support accurate and ethical note-taking for mental health professionals.
- NIMH (National Institute of Mental Health) — Contains research and information on perinatal mental health disorders, supporting evidence-based documentation practices.