Nobles in the 19th century would have given birth in the home and would have likely been attended by both a female midwife and a male obstetrician, although this varies geographically. In Europe, midwives were still commonplace well into the 19th Century, although they were largely phased out around the turn of the 20th century. If you're looking at a birth that took place in the late-19th century, you are more likely to see a male doctor in attendance that had a higher degree from a medical school, whereas births in the earlier part of the century would have been the domain of midwives, as the 19th century is a transitional period for obstetrics in which the field was professionalized. In most cases, an obstetrician would be brought in only if there were difficulties with the birth; in these situations, they would use forceps to deliver the baby.

The child's father would be brought in only after the baby was born, as childbirth was largely considered to be a feminine activity. Other people in the room would have included female relatives and close friends.

In terms of pain relief, the 19th century is a transitional period. Ether was introduced in 1846 and chloroform in 1847, and both were occasionally used during birth. There is evidence that Queen Victoria was given chloroform during childbirth in the 1850s. Many were critical of the use of pain relief during childbirth, as some believed that it made the birth go slower, and there was a level of skepticism concerning chloroform and the safety of the child. For nobles, the use of anesthesia would have depended on the patient.

Infant and maternal mortality rates were quite high in the 19th century, although they would have been determined by race and class as they are today (you can view some figures on that here).

Sources:

Borst, Charlotte. Catching Babies: The Professionalization of Childbirth, 1870-1920. Harvard University Press, 1995.

Bourke, Joanna. The Story of Pain: From Prayer to Painkillers. Oxford: Oxford University Press, 2014.

Brodsky, Phyllis L. “Where have all the midwives gone?.” The Journal of perinatal education vol. 17,4 (2008): 48-51.