On November 1, 1661, Queen Marie-Therese, the shy, retiring Spanish wife of King Louis XIV of France, went into labor. As soon as the Queen’s contractions began, her quiet palace rooms, in which she had been ceremonially confined for days, began to fill up with Princesses, Dukes and Countesses.

The birth of a royal baby was considered so important that it needed witnesses: queens often labored before great audiences of people, a factor that only increased their fear and misery during childbirth. In this case, the crush of courtiers was there to assure that a living baby was not substituted for a dead child, and that a royal baby girl was not switched for a desired boy.

Outside the palace a carnival-like atmosphere prevailed. “Spanish actors and musicians danced a ballet beneath the royal windows, with harps but also guitars and castanets to remind Marie-Therese of her native land,” Antonia Fraser writes in Love and Louis XIV. “It was hoped that these Spanish sounds diverted the poor queen, who kept crying out in her native language, “I don’t want to give birth, I want to die."

Her fears were not unfounded. Childbirth was a terrifying and deadly ordeal for women and their children in an era before modern medicine. Infection was common; one in three babies in France died before the age of one. And Marie-Therese was under overwhelming pressure to give the King a living male heir, thus ensuring the Bourbon succession.

After 12 hours of agony, the Queen finally delivered a healthy boy, who was named Louis de France. Courtiers in the inner rooms signaled the baby’s sex to those in outer chambers by hurling their hats up the air (arms were crossed if the baby was a girl). King Louis XIV, the flamboyant “sun king,” shouted out the window to his subjects packing the courtyard below, “The Queen has given birth to a boy!”

For many royal women, the pressure to provide an heir started as soon as the wedding celebrations ended. According to Randi Hutter Epstein, author of Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank, the 16th century French Queen Catherine de’ Medici was so desperate to become pregnant she sought out folk healers who told her to “drink mare’s urine and soak her ‘source of life’ in a sack of cow manure mixed with ground stag’s antlers.”

Once pregnant, expectant royal mothers were under constant scrutiny. Perhaps no birth was more hotly anticipated than Queen Marie Antoinette’s first baby in 1778. Although her mother, Empress Marie-Therese, had done away with public births in Austria, Marie Antoinette was unable to change the entrenched ways of Versailles. Early in the morning on December 19, the Queen rang a bell, signaling that her labor had begun.

Versailles quickly descended into chaos, as “avid sightseers” hurried in the direction of the Queen’s apartments, Fraser writes in Marie Antoinette: The Journey. The crowds “were mainly confined to outer rooms such as the gallery, but in the general pandemonium, several got through to the inner rooms.” Some royal onlookers were even “discovered perched aloft in order to get a really good view.”

In all the excitement, the Queen herself was practically an afterthought. After 12 hours, Marie-Antoinette delivered a small girl, named Marie-Therese after her grandmother. Although the child was not the desired boy, the Queen’s apartments became so raucous after the birth that Marie Antoinette had a seizure and fainted.

“The press of people, the heat and the lack of fresh air in the rooms, whose windows had been sealed up for months against the winter cold, was too much for her after her twelve-hour labour,” Fraser notes. It took a few minutes before anyone even noticed the Queen was unconscious. Eventually boards were ripped off the sealed windows bringing a gust of fresh air, which revived the dazed queen.

For the next 18 days, Marie Antoinette was kept in bed. Since her baby was female, Marie Antoinette was able to spend more time with her. “A son would have belonged more particularly to the state,” she tenderly explained to her daughter. “You will be mine; you will have my care, you will share my happiness and lighten my sorrows.”

The future Catherine the Great of Russia would not have the consolation of her child to make up for her horrendous delivery. In 1754, Catherine found herself essentially locked up by the Russian Empress Elizabeth for weeks in two small rooms in the Summer Palace, “isolated, with no company,” writes Robert K. Massie in Catherine the Great.

Immediately after Catherine delivered her son Paul on a small, hard mattress, Empress Elizabeth whisked the new heir away. Her husband Peter, the cruel, mentally ill heir to the Romanov throne, followed suit.

The parched Catherine was left shivering on the floor for over three hours without water, until the midwife returned. She was finally placed in her bed, but then left in the room for months on end. Unable to see her child, Catherine instead plotted her revenge.

There were some occasional attempts—however misguided—to give expectant royal mothers a more soothing birthing experience. Margaret Beaufort, the formidable, resilient mother of Henry VII of England, had experienced a horrendous delivery at the tender age of 13, when on the run during the War of the Roses. According to Sarah Gristwood, author of Blood Sisters, this trauma had understandably scarred her both mentally and likely physically (she never had any more children).

When her son became King, Margaret set down a careful protocol, which was to be followed during the birth of all her grandchildren:

Her Highness’s pleasure being understood as to what chamber it may please her to be delivered in, the same to be hung with rich cloth or arras, sides, roof, windows and all, except one window, which must be hanged so that she have light when it pleases her.

Weeks before she was due, the royal mother would have a final farewell party with her male servants. She would take communion and then enter what Gristwood calls a “world of women,” where “women are to be made all manner of officers, butlers, sewers and pages, receiving all needful things at the chamber door.” If she survived childbirth, the new mother would be sequestered in her chamber for 40 days. On the 40 day she would be “churched,” or purified and re-enter the royal household.

Although infant and maternal mortality remained high for all classes, royals had access to medical innovations that commoners generally did not. Professional midwifery emerged in 17th century France, and royal women employed the most skilled midwives of their time. Elites also had access to a promising new tool: obstetric forceps, which were invented in the 17th century by the Chamberlens, a French Huguenot clan of male midwives famed for their success in freeing babies struck in the birth canal.

One member of the Chamberlen family, Hugh, played a unique role in the most discussed royal delivery of the 17th century, says Epstein. In 1688, Mary Beatrice, the Catholic wife of King James II of England, went into labor at only six months pregnant. Protestants in England—particularly James’ two heirs from his first wife, Mary and Anne—were unhappy with the marriage, and even more fearful of the birth of a male heir who would usurp the women in the line of succession.

To make sure the birth was well documented, James II packed the delivery room with witnesses, leaving him to remark that “by particular providence scarce any prince was ever born where there were so many persons present.” Hugh, who had been summoned to deliver the child, arrived too late. A baby boy, named James, had already been born. Although he had missed the delivery, Hugh was asked to vouch for the baby’s royal authenticity. “I am certain that no such thing as bringing a strange baby in a warming pan could be practiced without my seeing it,” he proclaimed.

All of these precautions mattered little in the end: many Protestants, including Anne and Mary, refused to believe the premature child was not a changeling. This widely believed rumor was one of the main reasons James II was overthrown that year in the Glorious Revolution.

As the 19th century dawned, advances in medicine slowly made childbirth more bearable—and survivable. In 1853, Queen Victoria shocked many when she used chloroform to relieve her pain during the birth of Prince Leopold. Although archaic traditions still persist in some royal families, delivery rightfully became a more private affair.