Delicate Condition, a novel by Danielle Valentine, is a psychological horror story about Anna Alcott, an actress undergoing in vitro fertilization (IVF). The novel documents both the physiological strains of IVF and pregnancy as well as the psychological torment Anna endures as she comes to believe that outside forces are tampering with her pregnancy and that no one, not even her friends, husband, or doctors, truly believes her claims. Delicate Condition is the first novel for adults by Valentine, who has previously written young adult fiction as Danielle Rollins, Ellie Rollins, and Danielle Vega. As stated in the novel’s Author’s Note, Valentine was inspired to write Delicate Condition by her own experiences of pregnancy and miscarriage and by her friends’ experiences of not being listened to by the medical community. Delicate Condition was adapted into the 12th season of FX’s anthology series American Horror Story.  

This guide refers to the Sourcebooks Landmark first edition of Delicate Condition.

Content Warning: This guide refers to miscarriage, rape, depictions of self-harm, sexism, and misogyny.

Plot Summary

Delicate Condition follows the harrowing IVF and pregnancy journey of Anna Alcott, an NYC-based actress who has recently achieved fame. Anna is married to Dexter Harding, a successful businessman but emotionally distant partner. The novel opens with Anna hurrying to an IVF appointment—she’s late, even though her phone’s calendar says otherwise. In her haste, she ignores a strange woman in a blue baseball cap outside her apartment. On arriving, Anna undergoes egg retrieval with Dr. Hill, a woman who, despite being kindly, downplays Anna’s pain. On leaving, Anna bumps into a woman the receptionist identifies as “Ms. Preecher,” who surreptitiously takes a picture of her.

Life with Dex is strained. At home, he’s annoyed that Anna left out her perishable progesterone—ignoring her insistence that she put it in the fridge—and that Emily, Anna’s publicist, wants Anna to do more public appearances. That night, Dex and Anna go to dinner with Frank and Talia, two of Dex’s coworkers. Nervous about a pending call from Dr. Hill, Anna goes to the bathroom and calls her friend, the famous actress Siobhan Walsh. Siobhan comforts Anna, but when Anna returns, Dex is taking the call himself. Anna’s fumbles, he argues, indicate Anna is neglecting her treatment, even though she insists she’s trying her best.

The news from Dr. Hill is good: a high-quality embryo is ready to transfer into Anna. Anna remains nervous, though. She suspects that someone—possibly a cyberstalker—is tampering with her IVF treatment. This suspicion deepens when Anna, looking at her phone’s calendar, sees an appointment time change. Later that night, she wakes to find a strange woman in her bed who whispers “baby” in her ear. The woman flees before Anna can see her face; the police assign a detective to the case. A few days later, Anna discovers that she’s pregnant.

Talia allows Anna and Dex to move into her unoccupied Southampton home. One day, frightened by sudden symptoms of a miscarriage, Anna tries to call Siobhan. Instead, another woman answers—Olympia, one of Siobhan’s friends. At the Southampton hospital, Anna is attended by an ultrasound tech named Meg. When the doctor, Dr. Crawford, comes to confirm the miscarriage, he is confused: There’s no ultrasound tech named Meg at the hospital. Anna, feeling violated and devastated, goes home and calls Siobhan, telling her she’d do anything to get the baby back. Siobhan promises to come and keep Anna company. Anna drinks and, in her inebriation, thinks she can feel the baby moving.

These chapters are punctuated by brief interludes featuring women dealing with pregnancy in the past. In the 1980s, Io Preecher is coerced into becoming a surrogate by a friend; in 2018, a gynecologist-in-training who is skeptical of the medical establishment is recruited by a mysterious woman; in 1789, a woman gives birth to a monstrous creature; and in the 1950s, a despondent pregnant woman finds a stranger in her attic who wants to help her with the baby.

The next day, Anna receives a call from Siobhan’s daughter. Siobhan’s cancer has returned, and Siobhan is in the hospital. Devastated, Anna goes for a run on the beach, where she finds a doll of a character she once played with a red “X” drawn over its stomach. Anna returns to the house and, in the calendar that she believes her stalker has access to, writes “WHY ARE YOU DOING THIS?” (145). Emily calls shortly after, again prodding her to do more publicity. Anna explains the miscarriage, and Emily suggests that Anna spend time on the beach—a suggestion that disturbs Anna because Emily shouldn’t know that she’s on a beach. When Anna showers, she again feels a baby kicking inside her.

The stalker, in response to Anna’s query, says “they” did something to her baby. Anna makes an appointment with Dr. Hill, who doubts Anna’s claim that the baby is still alive. Not wanting to wait, Anna goes to the drugstore for a fetal heart monitor. The store clerk feels her stomach and confirms that there is movement inside. Elated, Anna goes home to Dex, who also feels the baby kicking. The baby starts kicking harder, though, until Anna feels her rib crack. At the hospital, Dr. Hill, confirms that Anna is, in fact, pregnant, and Anna’s rib is only bruised, not broken. It’s possible Anna had been pregnant with twins and miscarried only one; Anna is suspicious of this explanation, but doesn’t question it.

Another update from Anna’s stalker tells her not to trust anyone. Fearful of an information leak, Anna fires Emily and, once home, comforts herself by eating cookies that she assumes came from Dex’s workplace. When Dex reveals that he has no idea where the cookies came from, Anna starts to panic. She goes to the bathroom and, in her anxiety, tugs at her hair, which comes out in bloody clumps. In another consultation, Dr. Hill assures the anxious couple that this can be normal during pregnancy. That night, Anna hears a sound in the attic. On investigating, she finds a doll with its hair pulled out. The next day, the detective investigating Anna’s case calls her. The warehouse that produces the dolls in question has been broken into, and the thief matches Anna’s description of Meg.

As Anna’s pregnancy progresses, her relationship with reality becomes increasingly tenuous. One day, during a virtual yoga lesson, she coughs up a tooth. The tooth is later nowhere to be found. While drawing herself a bath, she feels the baby slicing through her from the inside, opening her stomach with a talon-like appendage. When Dex finds her screaming, Anna’s stomach is unharmed. At Dr. Hill’s suggestion, Anna goes on bedrest for the next few months.

One day, Anna finds a video posted by Io Preecher that seems to feature Meg. The video claims that Meg is a member of a satanic cult that induces unnatural pregnancies. Anna contacts Preecher about meeting. Meanwhile, odd cravings strike that prompt Anna to eat raw pork and then a live cat. She wakes the next day with a scale-like rash on her leg, which she tries to cut away. Preecher, agreeing to meet at a bar, shares her own story. Preecher was once a surrogate and went through everything Anna has experienced. Her doctor was also Dr. Hill.

Anna, disturbed by this revelation, begins to piece together who her stalker might be. She calls Dr. Hill’s office and confronts Cora, the receptionist, about tampering with her calendar. Cora confesses it was her, but she was trying to warn Anna: Dr. Hill sells information about women desperate to get pregnant to an outside party. Cora also admits to having an affair with Dex; Cora was the one in Anna’s bed that night, thinking that Anna was Dex. Anna, deeply hurt, blocks Cora’s number.

Anna confronts Dex, who confirms Cora’s confession. Anna goes into labor shortly thereafter and calls the only person who she might still trust—Olympia, Siobhan’s friend. Dex takes Anna to the hospital, and they fight on the way. Anna is so enraged and feels so monstrous that she bites off Dex’s finger, which causes him to crash the car. When she wakes, Dex is unconscious, and Siobhan is there in a blue baseball cap. Siobhan tells Anna that she—along with some other women in her “coven,” including Olympia but not including Emily, Cora, or Talia—have been the ones following Anna. Before Anna faints, Siobhan begins to perform a spell and tells Anna that she shouldn’t be afraid of her baby because “it’s a gift” (370).

When Anna wakes again, she’s in the hospital, giving birth. To her surprise, her baby girl is human in every way. Olympia visits afterward and explains that both Dex and Siobhan are now dead. Olympia and Siobhan are part of a coven of women who practice fertility magic. Siobhan had wanted to help Anna conceive. When Anna lost the baby and called Siobhan—but got Olympia on the phone—Olympia sent one of the coven’s ultrasound techs, Meg, to see if the baby was still viable. It wasn’t, but Siobhan decided to perform a spell to revive the baby, even though this spell would eventually cost Siobhan her life. To counteract the painful and hallucinatory effects of the unnatural magic, the women gave Anna cookies with healing herbs and used dolls to draw the pain away. When Anna stopped eating the cookies and moved the dolls, the negative effects of the spell returned.

Olympia then restores Anna’s entire memory of what happened after the car crash. Siobhan explained to Anna that the women of their coven have the ability, when they are close to death, to go on living as the child of another woman. She asks if Anna would consent to allow her to become Anna’s child; if Anna refuses, it’s possible her child would be adversely affected by the magic already in motion. Anna doesn’t respond immediately, grappling with her physical pain.

These chapters are, again, punctuated by interludes. In 2007, a woman tries to use dolls to mitigate the pain of her pregnancy; in the 1970s, a pregnant teen attempts a magical abortion that goes awry; in the 1800s, a new mother fears someone is trying to take her child; and in the 1600s, a pregnant woman watches the hanging of a midwife who she believes tampered with her pregnancy. The novel ends with a final interlude in which Anna, now a successful actress with a daughter named Siobhan, approaches a young woman at an IVF support group who is disillusioned with the medical establishment. Anna gives the woman a cookie and tells her about a group of women who might be able to help.