How reluctance to use interventions killed the heir to the British throne and the princess who bore him

Royal Gold Crown

The announcement of the first pregnancy of Kate, Duchess of Cambridge and future British queen has created a stir in the birth world. Many birth activists have suggested that Kate could set an example by having a home birth and avoiding interventions. Even the British, apparently, forget their own history. In one of the greatest tragedies of the British monarchy, another princess who would have become queen died precisely because everyone around her was afraid of birth interventions.

Princess Charlotte of Wales was the only child of George IV, and grandchild of George III, the king who presided over the American Revolution. Although George III had many sons, and they had dozens of illegitimate children between them, Charlotte was the only legitimate grandchild and was set to inherit the throne. Charlotte was wildly popular, seen as a breath of fresh air compared to her dissolute father and uncles. Her wedding to Prince Leopold, later King of the Belgians, in 1816 was greeted with widespread celebration. That the marriage was a love match, after Charlotte had refused her father’s preferred candidate, added to the feeling of joy. When months later the Palace announced her pregnancy, the public was thrilled.

According to Wikipedia:

Charlotte’s pregnancy was the subject of the most intense public interest. Betting shops quickly set up book on what sex the child would be. Economists calculated that the birth of a princess would raise the stock market by 2.5%; the birth of a prince would raise it 6%. Charlotte spent her time quietly, spending much time sitting for a portrait by Sir Thomas Lawrence.[89] She ate heavily and got little exercise; when her medical team began prenatal care in August 1817, they put her on a strict diet, hoping to reduce the size of the child at birth. The diet, and occasional bleeding, seemed to weaken Charlotte…

Much of Charlotte’s day to day care was undertaken by Sir Richard Croft. Croft was not a physician, but an accoucheur, or male midwife, much in fashion among the well-to-do.

Croft had calculated a due date of October 19, but Charlotte did not go into labor until November 3. Charlotte’s labor was protracted. Although she was fully dilated after 24 hours, she pushed for hour after hour. Today a diagnosis of arrest of descent would have been made and Charlotte would have undergone a C-section or a forceps delivery. She would have given birth to a healthy baby and perhaps complained about her “unnecessarean.”

Of course C-section was not an option then, but Croft had forceps and knew how to employ them. Nonetheless, he hesitated. Forceps were an intervention and could injure the baby, and Croft knew he would be blamed. He allowed Charlotte to push for 24 hours. Reportedly, for the last 6 hours of pushing, the baby’s head (more likely swelling on the top of the baby’s head) was visible. Finally, Charlotte’s son was born — dead. He had died sometime during the long labor. Less than 6 hours later, Charlotte herself was dead, reportedly dying from hypovolemic shock after a postpartum hemorrhage due to uterine atony, almost certainly a direct result of the extremely prolonged labor.

The country was plunged into mourning:

Henry Brougham wrote of the public reaction to Charlotte’s death, “It really was as though every household throughout Great Britain had lost a favourite child.” The whole kingdom went into deep mourning; linen-drapers ran out of black cloth. Even the poor and homeless tied armbands of black on their clothes. The shops closed for two weeks, as did the Royal Exchange, the Law Courts, and the docks. Even gambling dens shut down on the day of her funeral, as a mark of respect. Wrote The Times, “It certainly does not belong to us to repine at the visitations of Providence … there is nothing impious in grieving for that as a calamity.” Mourning was so complete that the makers of ribbons and other fancy goods (which could not be worn during the period of mourning) petitioned the government to shorten the period, fearing they would otherwise go bankrupt.

It is horrifying to contemplate Charlotte’s suffering and more horrifying still to realize that dozens of women around the world die each day for exactly the same reason: protracted labor ending with a stillborn baby and a fatal postpartum hemorrhage. And they die for the exact same reason Charlotte did, lack of interventions, though in their case, the interventions are unavailable, not unused.

Croft, who had hesitated to intervene with forceps, committed suicide several months later.

The “triple obstetric tragedy”—death of child, mother, and practitioner—led to significant changes in obstetric practice, with obstetricians who favoured intervention in protracted labour, including in particular more liberal use of forceps, gaining ground over those who did not.

The death of Princess Charlotte changed the course of British history. The race was on among her uncles, middle aged men, to produce a legitimate heir. That race was ultimately won by the Duke of Kent, whose wife gave birth to the baby girl they named Victoria. Victoria came to the throne in 1837 and reigned for more than 60 years, giving her name to the entire era.

It was said that Leopold never got over his loss, both the loss of his beloved wife and the loss of his access to the British throne. To regain the influence he would have had in Britain, he groomed his nephew, Albert of Saxe-Coburn-Gotha to marry his niece Victoria. The rest, as they say, is history. Albert’s (and therefore Leopold’s influence) changed Europe through his children and grandchildren including Kaiser Wilhelm of Germany, and Alexandra, Czarina of Russia, murdered in the Revolution of 1914. Indeed, his descendants are still on the throne of England to this day. The current Queen Elizabeth is Albert’s great, great, granddaughter.

I suspect that those who are hoping that Kate, the Duchess of Cambridge, will strike a blow for intervention free birth, are doomed to disappointment. The monarchy has “trusted” birth in the past and had cause to profoundly regret that decision.