Quality of maternal and newborn care, perinatal mental health and the emotional birth experience of women: findings of the IMAgiNE EURO study in Belgium.
Galle A., Vanderschueren J., Vercaempst V., Verdecchia M., Mariani I., Lorenzo G., Bomben A., Camanni M., Embo M., Vaerewijck N., Lazzerini M., IMAGINE GLOBAL STUDY GROUP .
OBJECTIVE: This study explored the quality of maternal and newborn care (QMNC) in Belgium, focusing on women's experience with care and their mental health (MH). DESIGN: We conducted a cross-sectional survey using the WHO-based IMAgiNE EURO questionnaire, updated with MH items. SETTING: All women who gave birth in a health facility in Belgium were included. PARTICIPANTS: Data were collected from 621 women who gave birth between March 2022 and January 2025. PRIMARY AND SECONDARY OUTCOME MEASURES: Descriptive statistics summarised QMNC and MH outcomes, while 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 healthcare providers and 8.2% reported abuse. Overall, 40.9% of women reported emotional difficulties related to childbirth, with 10% reporting a negative impact on well-being. MH screening and support were not structurally embedded in perinatal care. Emergency caesarean deliveries (adjusted odds ratio (aOR): 14.94), instrumental births (aOR: 2.36), fundal pressure (aOR: 4.11) and abuse (aOR: 3.74) were significantly associated with emotional difficulties around childbirth. The presence of an obstetric consultant (aOR: 0.44) and higher QMNC scores (aOR: 0.97) were associated with a lower likelihood of reporting emotional difficulties. CONCLUSIONS: 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, emphasising the need for further research into the underlying causal patterns and contextual factors shaping women's childbirth experiences.