The novel explores the multifaceted nature of motherhood through various characters and their relationships with their children. Rose's decision to leave her past behind to protect her child, juxtaposed with the experiences of the young unwed mothers at St. Elizabeth's, highlights the sacrifices, joys, and challenges inherent in raising a child.

Rose's arrival at St. Elizabeth's is driven by a desperate need to find a place where she can be accepted and loved unconditionally. The home, with its community of nuns and young mothers, offers her a sanctuary, a place to heal and potentially atone for past mistakes.

The novel is laced with secrets – from Rose's hidden past to the unspoken stories of the other residents at St. Elizabeth's. Patchett masterfully builds suspense as these secrets gradually unravel, revealing the characters' vulnerabilities and the consequences of their choices.