Quality of maternal and newborn care, perinatal mental health and the emotional birth experience of women: findings of the IMAgiNE EURO study in Belgium

ABSTRACT Background In Belgium, maternal and newborn health indicators indicate high quality of care compared to other countries of Europe. However, some challenges still persist in the quality of maternal and newborn care (QMNC) and little is known regarding women’s experience with care and their mental health (MH). Methods We conducted a cross-sectional survey among 621 women who gave birth between March 2022 and January 2025 in Belgium, using the WHO-based IMAgiNE EURO questionnaire, updated with MH items. Descriptive statistics summarized QMNC and MH outcomes, while multivariate logistic regression examined factors associated with negative emotional childbirth experiences. Results The median QMNC index was 260/300, suggesting high adherence to WHO quality standards. However, 33.5% of respondents reported ineffective communication, 34.0% a lack of involvement in decision-making, 8.7% no emotional support from health care providers, and 8.2% reported abuse. Overall, 40.9% of women reported emotional difficulties related to childbirth, with 10% reporting a negative impact on wellbeing. MH screening and support were not structurally embedded in perinatal care. Emergency caesarean sections (aOR 14.94, 95%CI), instrumental births (aOR 2.36), fundal pressure (aOR 4.11), and abuse (aOR 3.74) were significantly associated with emotional difficulties around childbirth. Protective factors included higher QMNC scores (aOR 0.97) and the presence of an obstetric consultant (aOR: 0.44). Conclusion Belgium shows a high level of QMNC, yet significant gaps remain in communication, MH screening and support, and adherence to evidence-based practices. Our study highlights a strong association between certain childbirth interventions and a negative emotional birth experience, emphasizing the need for further research into the underlying causal patterns and contextual factors shaping women’s childbirth experiences. Strengths and Limitations The study used a validated WHO standards–based questionnaire, ensuring comparable measurement of quality of care indicators. The updated questionnaire incorporated measures of emotional childbirth experience and perinatal mental health, addressing an important evidence gap in Belgian maternity care research. The overrepresentation of Dutch-speaking and highly educated women may limit applicability to the entire Belgian population. Participation was voluntary and data were self-reported, potentially leading to over- or underestimation of key outcomes, especially for sensitive topics such as mental health difficulties and experiences of abuse.