Dalton intercepts Cale on his way to find Rosaleen, and giddy with anger, Dalton insults Cale. Undeterred, Cale insists that he must save Rosaleen, but as he attempts to move past his brother to Rosaleen's bedchamber, Dalton kills Cale in a fit of fury. Rosaleen enters upon this scene, and driven mad, does not recognize that Cale is dead. Instead she sings about the artistic merits of his flowing blood, and then hallucinates a scene of domestic bliss with her three children, all while the pains of a premature childbirth heighten in her womb. She has a moment of clarity in which she realizes what Dalton has done, and though Dalton begs her to forgive him, she takes her revenge and stabs him with the same knife that has killed Cale. She sinks to the ground from these exertions into premature labor, where Alina finds her and tries to help. In the last scene, Rosaleen's parents wait anxiously for news of their daughter and the baby. Alina enters, holding a baby in her arms, and congratulates them, for the child has miraculously lived. Rosaleen, however, has died.
Alina holds the newborn child and reprises Rosaleen's song contemplating life and death. The ghost of Rosaleen joins her onstage with each of the spirits of her children as well as the spirits of Cale and Dalton.
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