After forgetting about the baby boy, Sara is filled with remorse; she quickly tells the father of the twins to make sure that the baby is held and loved. The twin babies remind her of herself and her twin, Caroline.
For most of the story, Sara Louise's sister, Caroline, is known as the pretty and sociable twin. Meanwhile, Louise has always had to live in her sister's shadow, seemingly forgotten and disregarded by those around her.
When Caroline leaves home to pursue a music career at Julliard, Louise is happy for her but filled with foreboding at her own ambivalent feelings. Things eventually come to a head when Caroline marries Louise's best friend, Call. Louise then decides to pursue her dreams; she initially enrolls in the University of Maryland to prepare for medical school but soon transfers to the University of Kentucky to study to be a nurse-midwife.
After graduating, she ends up serving in Truitt, a small Appalachian village in the mountains. Louise eventually marries a widower, Joseph Wojtkiewicz, and becomes a mother to his three children. Soon, a son, Truitt, is born to Joseph and Louise. Nevertheless, Louise continues her midwifery work, and one day, she is called upon to deliver twins.
The first twin is a baby boy, and he is born easily. However, his twin sister, in a breach position, is only born with some careful maneuvering on Louise's part. While Louise tends diligently to the twin sister, she finds herself forgetting about the baby boy. Eventually, she remembers that she has largely neglected him, and she orders the father of the twins to make sure that the baby boy is held and cherished.
Louise also advises that the baby boy be nursed by his mother and baptized. Although Louise is initially filled with remorse at having forgotten the baby boy, she does not dwell on her feelings. Briskly, she orders the father of the newborn twins to give equal attention to both babies. Drawing on her own painful experiences of having been largely ignored for most of her childhood, Louise tries to see to it that another baby does not suffer the same fate.