The birth and death of Carolyn Harrington, a girl with Down syndrome, are at the heart of this complex and sensitive debut novel set in Edmonton, Alberta. The medical establishment of 1947 regards baby Carolyn as an “unfinished child” and persuades her parents, Margaret and Donald, to place her in an institution where conditions turn out to be appalling. More than 50 years later, two Edmonton women in their late 30s confront issues that might destroy their lifelong friendship: just as Elizabeth Crewes gives up trying to have a baby after years of treatments for unexplained infertility, Marie MacPherson discovers to her surprise that she is pregnant with her third child, and then, following prenatal testing, that the child has Down syndrome. Shea develops the friendship between Marie and Elizabeth with insight into the competing desires of two women whose perfectionism makes them want to control the size of their families and the shape of their lives. At times, the exposition of the many medical issues Shea addresses in this novel can weigh down the dialogue, particularly in conversations between the women and their husbands. Yet the various strands of the plot come together in a gripping climax, raising compelling questions about moral responsibility in a 21st-century world that offers more choices than were available to the Harringtons decades before.