Giacinto Brandi (attrib.)
The Birth of the Virgin Mary
Most images of this type put the figures in a sumptuous or at least comfortable setting. Here the rough, dark look seems to allude to the future setting in which Mary will give birth to Jesus. Also unusual, especially for the 17th century, is the presentation of two successive moments in time: a post-partum moment with Anne lying in bed in the dim background, and a later time when she is sitting up with the child and the midwives in the well-lit foreground.
I would guess that the old woman on the left is Emerentia, Anne's mother and the grandmother of Mary.
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Read more about Mary's early years and about St. Anne and St. Emerentia.
Photographed at the cathedral by Richard Stracke, shared under Attribution-NonCommercial-ShareAlike license.