We are Phillip and Erin McCall. We know so many of you from years growing up in Middle Tennessee, and many others from our last decade of life in East Tennessee. We grew up about 10 minutes down the road from one another in Brentwood, but only met once we both arrived at The University of Tennessee in Knoxville in 2010. We’ve now been together for 10 years, and have been married for 7. Life seemed to break open in a new way this summer when we returned home from a weekend of joy and family reunion at Erin’s sister’s wedding in June. The Tuesday following Hannah’s wedding, still buzzing from the happiness of our family’s growth, we were somehow met with news of more growth, more happiness. We (after a lineup of unreadable pregnancy tests) discovered that we are pregnant with our first child. Later, we’d name him Wade Taylor McCall.

July 2021 started a slow revealing of the news, first to our immediate families, then gradually to a widened circle of loved ones. As Erin experienced an incredibly special and smooth first trimester, we had our sneaking suspicions that this baby may be a boy, though our plan was not to find out Wade’s sex prior to birth. We continued to work, travel and excitedly anticipate the coming change. On September 28th, we had our second ultrasound at our 20 week appointment with The University Midwives at The University of Tennessee Medical Center. During that ultrasound, three primary concerns were found in Wade’s development. We were able to see a very large bladder, low amniotic fluid levels and during this scan it was unclear if there were two developed kidneys- only one was visible. As our midwife delivered this news to us, we asked question after question. We were not fully grasping that these findings were significant and would change the course of our pregnancy. Our midwife was the first in a long line of professionals that sat with us, held our hands, spoke clearly with us, and went to bat for us. Phillip’s mom, Melissa, drove straight to us from Nashville to be with us and spent the night sleeping on the floor of Wade’s room. She steadied us in a moment that felt like the ground underneath us was shaking. We were transferred to The University of Tennessee’s High Risk Obstetrics practice, and were in for another scan with their office the following morning. This ultrasound confirmed an enlarged bladder and low amniotic fluid. We were able to confirm that two kidneys had developed, but that one was larger and showing signs of disease. Immediately after this next scan, our new Knoxville team introduced us to Wade’s diagnosis.

“Bladder Outlet Obstruction (BOO) is a condition that can develop during pregnancy. It is caused by a partial or complete blockage of the urethra. The urethra is the tube that allows the bladder to empty into the amniotic space, making it possible for the baby’s urine to maintain normal amniotic fluid levels. If not corrected, this blockage can cause backup of urine in the baby’s bladder and kidneys, which causes the bladder to enlarge and amniotic fluid levels to decrease. In severe cases, the baby cannot produce enough amniotic fluid, which can lead to damage to the bladder and kidneys and underdevelopment of the lungs, a life-threatening condition.” (From Cincinnati Children’s Hospital’s website) During this scan, we also found out that Wade is a boy. Bladder Outlet Obstruction is a condition more typical in boys. Where it was not our initial plan to learn the sex of our baby, we felt comforted to learn more about him.

As our team explained our diagnosis, they immediately made calls to connect us with the team at Cincinnati Children’s Hospital. Again, our Knoxville team surrounded us with care, and ensured that we were scheduled to see our new Cincinnati team the next morning. We made our way to Cincinnati that afternoon. We experienced a major shift as we headed north to Ohio. Where pregnancy had felt like a sweet, special time of trying on the role of “parents” to that point, we suddenly found ourselves acutely aware of the connection, protectiveness and fear we felt for our child. As this shift happened for us, our own mothers were jumping into action. Erin’s mom Pam was on the next flight to Cincinnati from Canada and Melissa drove us to Cincinnati as we made phone calls and tried to get a grip on our fast-changing logistics. We felt our own sense of parenthood for the first time as our mothers held our hands and kept us steady.

On our first day in Cincinnati, we were introduced to the Maternal Fetal Medicine specialists that have carried us through this process. One day, we would love to sit down with each of our loved ones and describe the tenderness and brilliance of this team. On day one, Erin underwent the first set of our in-utero procedures. The excess fluid trapped in Wade’s bladder was drained during a bladder tap procedure, performed simultaneously with our first amnioinfusion - in which fluid was provided to Wade, bringing his volume of amniotic fluid back to a stable level. The following day, another bladder tap was performed so that we might better understand how much fluid Wade’s kidneys had been able to produce in a 24 hour period. Next, we underwent testing and imaging to gain a better understanding of all the puzzle pieces of Wade’s diagnosis. Our echocardiogram showed that Wade’s heart shows no abnormalities. An MRI provided imaging that would be used in a panel meeting with our team of doctors from Neonatology, Maternal Fetal Medicine, Nephrology, Urology and Pediatrics. This meeting set us up with a plan for the way forward. The hope at this point was for us to return to Knoxville for weekly scans with our home high risk team. These scans would be to evaluate how much fluid was being produced by the kidneys, and how much fluid was able to release from the bladder. Our primary metric to pay attention to from week to week would be the measurement of Wade's deepest pocket of amniotic fluid. The hope would be for the deepest pocket of fluid to measure at least 2 cm. If this level could be maintained, we would be able to continue our care in Knoxville until about 32 weeks of pregnancy. Then, we would return to Cincinnati to make a birth plan.

We returned home with our new plan. Friends stepped in to feed us, hold us up, give us strength where we were lacking. We were able to stay on our course of Knoxville care for four weeks. On November 1, our scan revealed a drop in fluid. Our hearts felt broken again as we returned home to pack for another trip to Cincinnati. Our next scan in Cincinnati confirmed a low fluid level. Wade received another amnioinfusion, and our doctor let us know that the best next step would be to install an amnioport into Erin’s abdomen. Wade would need regular infusions of fluid moving forward, and up to this point we had been receiving direct infusions. Using the direct infusion method, a needle is inserted into Erin’s belly, and into her uterus to supplement fluid. Every time that procedure is performed, it disrupts the uterus, putting Erin risk for contractions and premature labor. Premature labor is what we are working to avoid at all costs. By installing a port into Erin, a tube would remain in the uterus, by which fluid could be infused without continual punctures with every procedure. A port creates more stability and easier access to Wade for more frequent infusions. A port also requires that we would be based in Cincinnati. So, we returned home to make plans for an earlier relocation than we had hoped for.

Our doctor cleared Erin to photograph one final event of family photo sessions, her annual event called The Fall Sessions- saying that this would be the last opportunity for Erin to take on shooting for the next stretch of time. We worked this event as a team with our dear friend Lauren. It felt like an incredibly sweet revolving door of beloved returning clients and wonderful friends that booked sessions - giving us an opportunity to say “see you soon.”

The following Monday was a full day of consent meetings, full of heavy questions and intimidating hypothetical outcomes. Then, on November 9, we reported to Cincinnati Children’s for surgery to install the amnioport. We spent the night and early morning prior managing our nerves as best we could. Erin remembers waking up after surgery and feeling like she had left her body as the team said, “Everything went beautifully!” To have made it to the other side of surgery without premature labor or complications for Erin or for Wade was relief beyond words. We stayed in the hospital overnight for observation, then were able to go back to our hotel to rest. Phillip then retuned to Knoxville to film a wedding, while Erin’s sisters came to the rescue as Erin continued recovery. Upon Phillip’s return, we moved into our new temporary home. We are now settled in to an apartment - we are able to have our dog Red with us, we are near a beautiful park, and we are able to have many of our comforts of home as our care continues in Cincinnati.

As we write this, the holidays are upon us. We look forward to Thanksgiving, then Christmas. To our loved ones that will celebrate Christmas as well, you may be starting to meditate on the Christmas narrative. The story of a family making a journey as they anticipated a baby boy, who was born in conditions that lacked stability and safety. We wonder about the timing of our path ahead. We hold the scene of the nativity in our hearts. The 32 week mark of pregnancy is a big milestone for us. This point in the pregnancy will be when Wade should be developed to a size that would allow him, if he were to be born at this stage, to have options available to him in terms of kidney care. We would love for Wade to be born as close to term as possible, but 32 weeks is a specific baseline goal that we would like to reach. In the timeline of our pregnancy, the 32 week mark is Christmas Day. This year, we anticipate Christmas on so many levels.

For those that have taken the time to read our story, thank you so much for your time and care. Through this process, we have been able to say with gratitude that we have not felt alone for a single moment. Our medical teams have been holy vessels of God’s love. Our loved ones have rushed to our rescue, meeting needs large and small, needs that overwhelmed us and needs we didn’t know we had. As the days and weeks pass, know that your love and support keep us steady. We cannot wait to meet this precious baby. We cannot wait till the day that each of you will meet him and tell him his story.