'I come from a long line of midwives. I was expected to follow Mama, follow Granny, follow Great-granny. In the end, I didn't disappoint them. Or perhaps I did. After all, there were no more midwives after me.' For generations, the women in Elizabeth's family have brought life to Kettle Valley, West Virginia, heeding a destiny to tend its women with herbs, experience, and wisdom. All the births and dates are recorded in tall black ledgers kept by Elizabeth's mother, but there is also a smaller, red ledger. Elizabeth does not always feel comfortable with her fate as a midwife and when she discovers the true purpose of the red book, to record fatal, unnatural and difficult births, she is shocked and disturbed by the contents. As Elizabeth loses faith in her vocation, she also loses her heart, to the one man who will never return her love, even when she moves into his home to share his bed and raise his child. She finds solace in mothering Lauren, her lover's child, but Elizabeth, who has brought so many lives into the world, must also come to terms with the fact that she herself is barren...