Obstetrics Anamnesis of the Empress Maria Theresia.

BACKGROUND: The peculiar reigning and private life of Maria Theresa in the tumultuous time of continuous wars in the then Europe was interwoven with her predominant maternal/obstetric history, as presented below.
OBJECTIVE: All the sixteen pregnancies of Empress Maria Theresa ended in spontaneous vaginal deliveries at term, with no information on pregnancies ended in spontaneous abortion or preterm delivery.
METHODS: Medicohystorical review of the obstetrical anamnesis of Empress Maria Theresia.
RESULTS: There were fifteen live births, whereas one female baby was born without signs of life. Cephalic presentation was recorded in fourteen and breech presentation in two deliveries, one of the latter with lethal fetal outcome. Thirteen deliveries were free from complications, whereas three deliveries, i.e. second, tenth and sixteenth, were very difficult, associated with obstetric complications including one manual lysis of the placenta with postpartum bleeding and two difficult deliveries with breech presentation. Maria Theresa had all her deliveries accomplished with assistance of the Court midwife (Hofhebamme), whereas the Court physician performed manual lysis of the placenta. Following delivery, the Habsburg-Lorraine archduke or archduchess was baptized by papal nuncio, but two children were baptized by the midwife in life-threatening conditions.
CONCLUSION: Considering her policy of renewing her multiethnic empire and its population that suffered great losses at various battlefields, Maria Theresa was a true representative and record-holder in perinatal contribution among the then courts worldwide.

BACKGROUND

Maria Theresa von Habsburg was born on May 13, 1717, at 7.32 a.m. at the Hofburg Palace in Vienna, as the second child of Holy Roman Emperor Charles VI and Elisabeth Christine of Brunswick-Wolfenbüttel. When her father, Emperor Charles VI, died in October 1740, Maria Theresa started reigning the powerful Danube Habsburg Monarchy for 40 years and a month, based on her father’s Pragmatic Sanction of 1713. On February 14, 1736, at the age of 19, she married Franz Stefan de Lorraine, 9 years her elder, and gave birth to sixteen children between age 20 and 39, including eleven female and five male children, ranking her first among multiparous sovereigns. Three children died in childhood and another three as young persons, while her two sons, Josef II and Leopold II, were hereditary sovereigns of the Monarchy (1780-1790 and 1790-1792, respectively) (1-6).

The peculiar reigning and private life of Maria Theresa in the tumultuous time of continuous wars in the then Europe was interwoven with her predominant maternal/obstetric history, as presented below.

EMPRESS MARIA THERESA PREGNANCIES AND CHILDBIRTHS

When Maria Theresa, Archduchess of Austria and Queen of Hungary and Bohemia, conceived and pregnancy reached three months, her pregnancy had to be proclaimed, while she was carried in a sedan chair during processions. There is information that Maria Theresa underwent venipuncture on three occasions during pregnancy, i.e. at the beginning, in mid-pregnancy and short before delivery term, with 0.5 L blood evacuated per venipuncture (4). On these occasions, the high nobility assembled and congratulated the Empress because the procedure was then also considered ceremonial for good luck at delivery (2).

When initial labor pains occurred, solemn mass was held for favorable delivery outcome in the Court chapel in winter residence Hofburg Palace or summer residence Schönbrunn Palace, depending on the location where Maria Theresa resided and where delivery would take place (3). Upon initiation of labor pains, Maria Theresa used to withdraw to the living room accompanied by her mother, the court midwife, the principal lady-in-waiting, her Aja, countess Maria Karoline Fuchs (Maria Theresa called her Mami), and dry nurses. Court physicians were informed on the labor initiation and were awaiting to be called by the midwife if their intervention was required; however, Maria Theresa had all her deliveries accomplished with assistance of the Court midwife (Hofhebamme), whereas the Court physician performed manual lysis of the placenta (2-4). Freiherr von Steger was Court physician until arrival of Gerard van Swieten; when van Swieten died in 1772, Freiherr Anton von Störck was appointed Court physician (1, 3).

At the time, deliveries were conducted exclusively on a delivery chair; however, after having had the first six deliveries in a delivery chair, the remaining ten deliveries Maria Theresa had performed in the bed. Home relics were placed in the room where delivery was planned to take place. All the sixteen pregnancies of Maria Theresa ended in spontaneous vaginal deliveries at term, with no information on pregnancies ended in spontaneous abortion or preterm delivery. There were fifteen live births, whereas one female baby was born without signs of life. Cephalic presentation was recorded in fourteen and breech presentation in two deliveries, one of the latter with lethal fetal outcome. Thirteen deliveries were free from complications, whereas three deliveries, i.e. second, tenth and sixteenth, were very difficult, associated with obstetric complications including one manual lysis of the placenta with postpartum bleeding and two difficult deliveries with breech presentation (Table 1) (2-6).

	Name and baptismal name of the Maria Theresian children (Archduke / Archduchess (nickname))	Date and place of birth	Obstetrics / midwifery data	Death
1.	Maria ElizabethMaria Elisabeth Amalia Antonie Josephe Gabriele Johanna Agathe	5.2.1737.Hofburg	Midwife (Hofhebamme)Chair deliveryHead presentation	7.6. 1740.sudden death, Frass
2.	Maria AnnaMaria Anna	5.10.1738.Hofburg	Midwife (Hofhebamme)Chair deliveryHead presentationPostpartum hemorrhage, retained placenta (manual removal of placenta)(dr. Freiherr von Steger)	19.11.1789.
3.	Maria KarolinaMaria Carolina	12.1.1740.Hofburg	Midwife (Hofhebamme)Chair deliveryHead presentation	25.1.1741. sudden death, Frass
4.	JosephJoseph Benedict August Johannes Anton Michael Adam	13.3.1741. after 2,00Hofburg	Labor began 12.3. u 23,00, delivery after 3 hoursMidwife (Hofhebamme)Chair deliveryHead presentation	20.2.1790.tuberculosis
5.	Maria ChristinaMaria Christina Johanna Josepha Antonia (Mimi, Mimerl)	13.5.1742.Schönbrunn	Midwife (Hofhebamme)Chair deliveryHead presentation	24.6.1798.
6.	Maria Elisabeth IIMaria Elisabeth Josepha Johanna Antonia (Liesl)	13.8.1743.afternoonSchönbrunn	After journey through the empire, MT received strong labor and quick birth Midwife (Hofhebamme)Chair deliveryHead presentation	22.9.1808.
7.	Karl JosephCarolus Josephus Emanuel Joannes Nepomucenus Antonius und Procopius	1.2.1745.Hofburg	After strong labor and quick birthMidwife (Hofhebamme)Bed deliveryHead praesentation	18.1.1761.pox
8.	Maria AmaliaMaria Amalia Josepha Johanna Antonia (Mali)	26.2.1746.20,30-20,45 Hofburg	Midwifery (Hofhebamme)Bed deliveryHead praesentation
9	Peter LeopoldPetrus Leopoldus Josephus Johannes Antonius Joachim Pius Gothardus (Poldl)	5.5.1747.Uuntill noon Schönbrunn	Head praesentationMidwife (Hofhebamme)Bed deliveryHead praesentation	1.3.1792.
10.	Maria KarolinaErnestine Antonie Johanna Josephe	17.9.1748. 19,30 Schönbrunn	Midwife (Hofhebamme)Bed deliveryFoot praesentationDifficult birthEmergency baptism	17.9.1748. Stillbirth
11.	Johana GabrielaJohanna Gabriela Josepha Antonia (Hannerl)	4.2.1750.Hofburg	Midwife (Hofhebamme)Bed deliveryHead prsesentation	23.12.1762.Pox
12.	Maria JosephaMaria JosephaSepherl	19.3.1751.Hofburg	Midwife (Hofhebamme)Bed deliveryHead praesentation	15.10.1767.Pox
13.	Maria Karolina IIMaria Carolina Ludovica Josepha Johanna Antonia (Charlotte)	13.8.1752.Schönbrunn	Midwife (Hofhebamme)Bed deliveryHead praesentation	8.9.1814.
14.	Ferdinand Karl AntonFerdinand Carl Anton Joseph Johann Stanislaus	1.6.1754.Schönbrunn	Midwife (Hofhebamme)Bed deliveryHead praesentation	24.12.1806.
15.	Maria AntoinetteMaria Antonia Josepha Johanna (Tonerl)	2.11.1755. 12,00Hofburg	Midwife (Hofhebamme)Bed deliveryHead praesentation	16.10.1793.guillotined
16.	Maximilian FranzMaximilian Franz Xaver Joseph Johann Anton Wenzeslaus	8.12.1756. 13,00Hofburg	After breakfast labor ensuedMidwife (Hofhebamme)Bed deliveryBreech praesentationHyperthrophic newbornDifficult birthEmergency baptism (Jordan wather)	26.7.1801.

Following delivery, the Habsburg-Lorraine archduke or archduchess was baptized by papal nuncio in a ceremony held in Rittersaal in Hofburg Palace or Zeremoniensaal in Schönbrunn Palace, giving the newborn his/her name. All children born to Maria Theresa were baptized in the Palace where they were born, ‘secured’ by the home relics. Two children were baptized by the midwife in life-threatening conditions. Maria Theresa did not allow any amulets to be put on her children during childhood (2-6). Her children called her Frau Mama or Maman. It is known that Maria Theresa breastfed her children if her reigning duties allowed it, and later they were breastfed by wet nurses (Ger. Saugamme); wet nurse’s breast milk (Ger. Ammenmilch) was called Gespinn. Each child had his/her own wet nurse (Ger. Amme, Aja). Special attention was paid to the children’s health and hygiene; among others, pediatric dentist was coming twice a week to clean and care for the teeth of the archdukes and archduchesses (1-6).

DISCUSSION

Multiparity and high birth rate associated with high perinatal mortality rate were demographic and perinatal characteristics of the 18th century Europe. During the nineteen years of her reproductive age, Maria Theresa gave birth to sixteen children, which was a rarity at European courts in spite of the then demographic pattern and high birth rate. In collaboration with Gerard van Swieten, the then Monarchy health care consultant and her personal physician, whom she had invited to come from The Netherlands to Vienna, on September 17, 1770, Maria Theresa published Normativum sanitatum, a collection of regulations on health care in the Monarchy, proclaiming the efforts of Maria Theresa and the Vienna Court for healthy offspring and healthy nation (Maternas curas) (1, 7-10).

Maria Theresa used to name her newborns after her dead children, thus imbuing them with new life; so, she gave birth to Maria Elisabeth II and Maria Karoline II. It may be interesting to note that four of her children were born on day 13 of the month, a day she had also been born in the era of spontaneous, noninduced deliveries. Her deliveries are described as spontaneous and fast, typical for multiparas; however, two of her deliveries were complicated by fetal malpresentation, which is not unexpected considering her parity (1).

Although such a high parity was not recorded among Maria Theresa’s close family members at other courts, there are some other curiously high numbers of childbirths, e.g., her son and later Emperor Leopold II had sixteen children with his wife Maria, just like his parents, i.e. twelve sons and four daughters, whereas Ferdinand Karl Anton, the next to the last son of Maria Theresa and Franz I, and his wife Maria Beatrice had twelve children, six of them born on delivery chair and another six in the bed; however, Maria Beatrice appreciated chair delivery for being much more comfortable and easier (8). In her letters to her daughters and daughters-in-law, Maria Theresa supported and encouraged them with her multiparous experiences and advice for the best possible pregnancy and delivery outcome (3).

CONCLUSION

Considering her policy of renewing her multiethnic empire and its population that suffered great losses at various battlefields, Maria Theresa was a true representative and record-holder in perinatal contribution among the then courts worldwide. As a sovereign having given birth to sixteen children, she was a true Mother Empress remembered in the global history, social history, and history of obstetrics and midwifery. With her practical Catholic upbringing she used to proclaim as a sovereign and mother, she advocated the 18th century humanist philosophy and Enlightenment. Thus, the entire historical period characterized by her reign in the Baroque Catholicism spirit is known as the Maria Theresa era.