The author of Break in Case of Emergency follows up with a moving novel about motherhood and marriage, adolescence and bodily autonomy, family and love, religion and sexuality, and the delicate balance between the purity of faith and the messy reality of life. Book-smart, devoutly Catholic, and painfully unsure of herself, Jane becomes pregnant in high school; by her early twenties, she is raising three children in the suburbs of western New York State. In the fall of 1991, as her children are growing older and more independent, Jane is overcome by a spiritual and intellectual restlessness that leads her to become involved with a local pro-life group. Following the tenets of her beliefs, she also adopts a little girl from Eastern Europe. But Mirela is a difficult child. Deprived of a loving caregiver in infancy, she remains unattached to her new parents, no matter how much love Jane shows her. As Jane becomes consumed with chasing therapies that might help Mirela, her relationships with her family, especially her older daughter, Lauren, begin to fray. Feeling estranged from her mother and unsettled in her new high school, Lauren begins to discover the power of her own burgeoning creativity and sexuality-a journey that both echoes and departs from her mother's own adolescent experiences. But when Lauren is confronted with the limits of her youth and independence, Jane is thrown into an emotional crisis, forced to reconcile her principles and faith with her determination to keep her daughters safe. The Fourth Child is a piercing love story and a haunting portrayal of how love can shatter-or strengthen-our beliefs.