1. Tara and Emerson have very different personalities, yet they’ve remained best friends for more than twenty years. What do you think drew them together initially? What keeps them together now?
2. Tara’s mother had a history of psychiatric problems. How has this shaped Tara as a mother? As a widow?
3. Imagine yourself in Noelle’s place when she learns that Emerson is her sister. Would you be able to keep that relationship to yourself for two decades? Do you think Noelle should have revealed the relationship to Emerson? Discuss the internal struggle you might have if you were in her position.
4. What was Sam’s attraction to two women as different as Tara and Noelle? Why do you think he chose Tara over Noelle?
5. Emerson values being liked above being ambitious and successful. This is typically a feminine trait and one that can often get in the way of advancing in a career. Yet Emerson, with her new café, Hot!, has clearly found a path to professional success without sacrificing her values. Why do you think she’s succeeded at this endeavor? How do you feel about the sometimes conflicting values of “being nice” vs. “being ambitious”?
6. Grace is a strong introvert, while her mother is passionately extroverted. How do these differing personality traits affect their relationship?
7. Tara has enormous guilt over her feelings toward her former favorite student, Mattie Cafferty. Discuss how her relationship with Mattie may have impacted her relationship with Grace prior to Sam’s death.
8. Any major change often throws the structure of a comfortable family out of balance. Why do you think Grace had such a close relationship with her father? How did the family dynamics between Grace, Tara and Sam support that relationship? How did Sam’s death alter those dynamics and what did that change mean for both Grace and Tara? Discuss the different ways in which Tara and Grace grieved for Sam and how those different styles of grieving created conflict and misunderstanding.
9. Anna has made the search for missing children her life’s work and has involved Haley in that cause in both a professional and personal way. How do you think this has impacted the relationship between mother and daughter?
10. Bryan deserted Anna and Haley during the most vulnerable time of their lives. When he returns, they both need his support, but does Anna forgive him too easily? How does her role as a mother and/or a woman feed into that forgiveness?
11. How are the three mother/daughter relationships (Tara and Grace; Emerson and Jenny; Anna and Haley) the same or different?
12. Discuss Noelle’s choice to become a gestational surrogate. Why did she choose this particular path to atonement? Why do you think she had no children of her own?
13. Noelle lived not just one lie, but many. Discuss what it must be like to keep the most significant parts of your life a secret from your closest friends. When Ian learns about her surrogacy, he says “It must have been so lonely, being Noelle.” Do you think Noelle was lonely and if so, were they ways that she compensated for that loneliness?
14. Imagine yourself in Emerson’s place when she feels certain that Noelle substituted Grace for Tara’s infant. How would you feel knowing such devastating information about your best friend? Would you handle it the way Emerson did or in some other way?
15. As the reader, you’re unable to see the world through Grace’s point of view until the final third of the story. Did that impact how you perceived Grace? Did being in her point of view change your feelings about her?
16. Tara learns that her missing daughter is not her biological daughter and at the same time realizes that her biological daughter is dead. What does she learn about herself as a mother in those moments?
17. Anna’s reaction to Grace’s arrival at the hospital is conflicted and hesitant. Did this surprise you? Do you think some sort of maternal intuition came into play in this scene or was some other emotion at work? Discuss Anna’s reaction to Grace’s pronouncement that she is Anna’s daughter.
18. Noelle is a powerful woman even from the grave. Every character in the story has been hurt by her in some way. Yet ultimately this is a story of forgiveness. Trace the complicated relationships Tara and Emerson had with Noelle. Why do you think they are able to make peace with Noelle’s hurtful actions?
19. The Midwife’s Confession is also a story about deep and abiding friendships between women. What would you say is the ultimate take-away message about friendship?
20. Who do you think grew the most over the course of the story and why? What do you think the future holds for Tara and Grace? Emerson and Jenny and Ted? Anna, Haley and Bryan?