The book opens in the heart of a dormant volcano and takes place in a brutal ancient world transformed by genocidal pestilence, war, fierce beauty, and cultural devastation.

[1][2] This world has an early medieval culture with “decadent imperial civilizations,”[3] small city states, nomadic groups, constant little wars and skirmishes and conquests, swords and primitive cannons, multiple religions worshipping various deities, and powerful but mysterious magic.

[6] After emerging from the volcano, the narrator encounters a village that reveres her as a goddess due to her healing powers and her inhuman face, which she considers hideous.

She continues to the cities of the White Desert and becomes the goddess of a decadent civilization fighting for the deceitful sorcerer-conqueror Vazkor, who uses the narrator as his instrument of power.

Leaving the cities, she is enslaved by a tribal krarl, gives birth to Vazkor's son, wanders onward, battles a dragon, and encounters a spaceship from a distant advanced civilization.

[7][8] With the publication of The Birthgrave by DAW, Tanith Lee entered the science fiction field, and her career rapidly took off thanks to the emotional depth of her narrative and her female protagonists.

[9] Much of the novel is based on Lee's own dreams where she was in the place of its narrator, which she describes as, ”we rose from fire and from death, fell deep into passions of love, raced the chariots…and withered and regained our destiny."

She was also very fascinated by Gaskell's take on sexual romance and psychology and how she flowed the two different writing styles into one[13] DAW was very interested in her story and chose to publish her, which turned out to be quite the success.

[17] Critics have praised its “genius”, emotional depth, uniqueness[15] and Lee's immense talent at creating a fluent and imaginative map for the reader through a sword and sorcery epic plot.

Critics reveal that the author effortlessly sustains both ultramodern and primeval genre's integrity of the world she has created, no matter how unusual or unique her writing approach may be.

The Washington Post noted Birthgrave as novel featuring "vigorous heroines, often a warrior or a sorceress” who eventually finds herself as she travels on her quests.