Personal Support Plan

Perinatal mental-health education • Resources • Community

How to use this plan

Type directly into the fields and then print the completed worksheet or save it as a PDF using your browser’s print menu. You can also print it blank and fill it out by hand. Consider reviewing it with a healthcare professional and the people you trust.

Green Side — Personal Perinatal Support Plan

1. My Care Team

Keep important care contacts together so you or a supporter can find them quickly.

OB-GYN / midwife / prenatal clinician

Primary-care clinician

Therapist / psychiatrist / mental-health professional

Preferred hospital / urgent-care location

Pharmacy

Important care or insurance notes

2. My Support Circle

Primary support person + phone

Second support person + phone

Transportation support

Meals / household support

Childcare / dependent / pet support

3. My Usual Baseline

Knowing what is typical for you can make meaningful changes easier to notice.

When I am doing well, my usual mood, sleep, energy, appetite, and communication look like:

People, routines, places, or activities that usually help me feel grounded:

4. Changes I Want People to Notice

I withdraw or stop responding to people. I seem much more anxious, panicked, or on edge than usual. I cannot sleep even when I have a realistic opportunity to rest. I become unusually irritable, agitated, or overwhelmed. I repeatedly check, seek reassurance, or avoid things because of distress. I struggle significantly with normal daily tasks. My mood or energy becomes dramatically different from my usual self.

Other changes that are important for me:

5. Practical Support Preferences

Things that help me feel supported:

Things I would prefer people NOT do or say:

6. Sleep & Rest Plan

Sleep can be affected by pregnancy, recovery, infant care, feeding, pain, anxiety, and other factors. Use this section to make responsibilities explicit.

Who can help protect realistic periods of rest?

How can overnight / early-morning responsibilities be shared when possible?

Changes in sleep I want to discuss with my clinician:

7. Appointments & Questions

Symptoms or changes I want to mention:

When they started / how often they occur:

How they affect daily life:

Questions I want to ask:

Follow-up date / next step:

8. Supporter Responsibilities

Person + task

How I want supporters to approach me if they notice a change:

9. If I Need More Support

Write down the next level of support you and your care team have discussed. This is a planning section, not a substitute for professional evaluation.

Who I want contacted first

Clinician / after-hours contact instructions

Preferred hospital or evaluation location

Urgent situations: Sudden severe confusion, major disorganization, loss of contact with reality, or an immediate medical or safety emergency requires urgent professional help. In the U.S., call 911 for an immediate emergency or use 988 for crisis support. The National Maternal Mental Health Hotline also offers 24/7 call, text, and web chat with trained counselors.

10. Post-Appointment Follow-Up

What I learned / recommendations I received

My next appointment

Questions I still have

What my supporters need to know

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Green Side Guide
Site navigation & education

Hi! I can help you find information on Green Side, supporter resources, care directories, or the support plan. I don’t diagnose conditions or replace a healthcare professional.