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.