It's after midnight and an overdue Kendra Duval sits on the edge of her bathtub after two days in early labour, her waters finally broken and intense contractions underway.
She prepared for a hospital birth, but there isn't one for her to go to. Her husband is on the phone with a nurse at a hospital in the small town of Winchester, Ont., trying to figure out where to drive.
They should already be headed to Winchester, but its birth unit has been closed overnight due to staffing shortages.
Duval knows the baby is coming. She can't stop her body's contractions or slow them down. "It was definitely the scariest moment of my entire life," she said.
After the scramble that happened next, the couple wants people to know that health care in the province urgently needs fixing, and that staffing problems extend beyond some hospital emergency rooms.
"I should be here relaxing and recovering from birth and just enjoying my baby. But I'm so mad that that happened to me, and I'm so upset that that might happen to somebody else, that I feel like I have to say something about it," she said.
Until a week before her Nov. 20 due date, Duval had no idea her hospital's obstetrics unit could just stop running.
She found out haphazardly, at a routine checkup with her OBGYN.
Duval, her husband and four-year-old daughter live in the small eastern Ontario community of Russell, Ont., a half-hour drive southeast of downtown Ottawa. The couple chose to have their second child at the Winchester District Memorial Hospital, also a half-hour drive, because of its great reputation in obstetrics.
Staff at her OBGYN's office said they were running late; the doctor had to help women needing induction who couldn't go to the hospital that night because the birth unit didn't have enough staff to stay open.
Now I feel like everything is in jeopardy again because maybe we won't have help in the moment, whenever the time comes.- Kendra Duval
Duval, "blindsided" by what she heard, asked what would happen to her in that situation. She was told hospitals regularly communicate with each other, another hospital would take her if the need arose, and not to worry.
But she did worry. She had recently suffered a miscarriage and was being closely monitored as a result. And this time, COVID-19 and other viruses left her ill on several occasions.
"I said to my husband, I've spent nine, 10 months doing everything I can to protect this baby and make sure that he's safe. And now I feel like everything is in jeopardy again because maybe we won't have help in the moment, whenever the time comes."
When the time came — the night of Nov. 22, after two days of early labour — Winchester's birth unit was going to be shut down from 11 p.m. to 7 a.m. due to a lack of staff.
"These short-term closures usually happen a few times per year but with the staffing challenges affecting all of health care, it happened more often earlier this year and through the summer," hospital spokesperson Jane Adams told CBC News in an email.
"In November, the unit was closed six times, for between eight and 12 hours, each time due to staffing."
Across the province this year, 25 hospitals have temporarily closed their birthing units at least once since July 6 (when Ontario Health started tracking the problem) because of staff shortages.
Ontario Health would not provide a list of which hospitals closed birth units.
Another hospital could take them, but then couldn't
Duval was just shy of the threshold to be admitted when she arrived at Winchester hospital before the birth unit closed. The nurse who'd been checking her progress over the past two days told her to come back in the morning to have her waters broken if that didn't happen on its own.
"I broke down crying. I said, 'I'm really scared that it's coming, that something's going to happen in the night and you're going to be closed,'" Duval recalled.
So the nurse arranged the paperwork for Duval to go to Ottawa's Montfort Hospital if labour progressed, Duval said.
About 45 minutes after getting home, her waters broke. Her husband called Montfort to say they were on their way, but Montfort said it no longer had room and to call The Ottawa Hospital's General campus instead.
Duval's partner called the nurse in Winchester. The General didn't have room either, she reported back, but Ottawa's Queensway Carleton Hospital did.
It was an hour away.
"She could hear me screaming in the background, and so she ended up telling my husband, come back to Winchester, I'll reassess you. And if need be, maybe we can get an ambulance to take you," Duval said.
They arrived at the ER to re-register. It was too late to go anywhere else.
"I was completely panicked. I was erratic. ... Everything was happening so fast. I kept saying to them ... I can't do this, I'm going to die, I just didn't feel safe," Duval recalled.
The nurse coached her through, with another borrowed nurse and ER doctor, until an OBGYN showed up 40 minutes later just in time to deliver the baby.
I don't think that anyone deserves to be put in that situation; not me as the mother, but not her as someone just trying to do her job.- Kendra Duval
A short umbilical cord was wrapped around his neck — too short to be moved by hand. It had to be cut while the birth was still happening, and then staff worked on him for 15 minutes to make sure he was OK.
Duval said the staff were "amazing" — she and her husband aren't upset with the hospital at all — but that the situation was unfair on all of them.
"[The nurse] sent me home as safely as she could in the moment, only to find me back there ... completely erratic, in full labour, with no time to spare. I don't think that anyone deserves to be put in that situation; not me as the mother, but not her as someone just trying to do her job," she said.
"They've gone above and beyond for us, but we feel that the system has failed us overall, and failed them as well," Ken Duval added.
'We deserve better than this'
Last week, Ontario's five largest health-care unions announced that staff turnover is running at nearly 15 per cent, and hospitals need to hire 47,000 people to fix the issue and meet the needs of a growing, older population. They also admonished the province for trying to cap wage increases at one per cent.
The province announced Thursday that a record number of nurses — nearly 14,000 — had registered in Ontario so far in 2022, and that it was investing $14 million to register more.
Duval said health-care staff deserve more money and appreciation to attract workers.
"Without those people, where are we? They deserve more respect than this, and as regular people just trying to raise a family, we deserve better than this, too. Something has to change and it has to change now," she said.
"I'm just afraid. Afraid that health care will fail me again, fail [my son]."
Kendra and Ken Duval said hospital staff "did the best with what they had" to help the couple deliver their son after a maternity ward closure upended their birth plan.
Closing unit 'the safest option,' hospital says
In a statement, Ontario's Ministry of Health said it expects hospitals "to ensure all impacts are considered as they work toward delivering the most appropriate range and quality of health-care services and programs for patients and residents, within available resources."
Families are encouraged to speak with their health-care providers "and work together to develop an approach that ensures patients have the right care when needed."
None of the hospitals involved would comment directly on Duval's situation, citing patient confidentiality.
Winchester hospital said it "makes every effort" to find another hospital for patients when the birth unit closes, and closing "is the safest option" when not enough staff are available. It hopes its "almost full" staff complement will reduce closures.
Montfort Hospital said it can usually accommodate all patients at its birth centre, but when a lot of people are already admitted, "we may not be able to provide the level of care they all require."
"Like other hospitals in the province, Montfort is experiencing nursing shortages. Closures of maternity wards in neighbouring hospitals do impact us as well," its statement reads.