Quality of maternal and newborn care and mental health: findings from the IMAgiNE study in Belgium
A Galle, J Verschueren, V Vercaempst, M Verdecchia, I Mariani, LG Cora, M Camanni, M Embo, M Lazzerini, N VaerewijckAbstract
Background
Overall, Belgium has robust maternal health outcomes, yet gaps persist in women’s experience of care and perinatal mental health (MH). Regional variations in clinical practices — caesarean rates, inductions, episiotomies — highlight the need for standardised, evidence-based approaches. Data on women’s experience and the emotional birth experience remain scarce, representing a significant blind spot in quality of care research.
Methods
A cross-sectional survey was conducted using the WHO-based IMAgiNE questionnaire, updated with perinatal MH items. All 621 women who gave birth in a Belgian health facility between March 2022 and January 2025 were eligible. Descriptive statistics summarised the quality of maternal and newborn care (QMNC) and MH outcomes; multivariable logistic regression identified factors associated with a negative emotional childbirth experience.
Results
The median QMNC index was 260/300, reflecting high adherence to WHO standards. Yet, 33.5% of women reported ineffective communication, 34.0% a lack of involvement in decision-making, 8.7% no emotional support, and 8.2% reported abuse. In total, 40.9% experienced emotional difficulties related to childbirth; 10% reported a negative impact on wellbeing. MH screening was not structurally embedded in perinatal care. Emergency caesarean (aOR 14.94), instrumental birth (aOR 2.36), fundal pressure (aOR 4.11), and abuse (aOR 3.74) were significantly associated with emotional difficulties. The presence of an obstetric consultant (aOR 0.44) and higher QMNC scores (aOR 0.97) were protective factors.
Conclusions
Belgium demonstrates high overall QMNC, yet significant gaps persist in communication, MH screening, and adherence to evidence-based practice. Specific obstetric interventions are strongly associated with negative emotional birth experiences, underscoring the need for further research into causal pathways and contextual factors shaping women’s childbirth experiences.