When Mena Coote's water broke in her St. Catharines, Ont., home, she never dreamed that nine hours later she would be giving birth across the border in Buffalo -- to two tiny citizens of both the United States and Canada.
"It was a little bit crazy," Coote said Monday of her preemie twins.
The babies will enjoy dual citizenship for their entire lives simply because their Canadian mom happened to go into premature labor just as all of the neonatal intensive-care units in Ontario ran out of beds -- and the only place that could take her was Buffalo's Women and Children's Hospital.
The bizarre international birthing adventure began at about 4 p.m. Jan. 18, when Coote went into labor 10 weeks early.
She already had known her pregnancy was in the high-risk category. Not only was she having twins, but Coote, 31, developed a blood clot in her leg during her first trimester, forcing her to be on bed rest for most of her pregnancy.
Once every two weeks, she visited specialists at McMaster University Medical Center in Hamilton, about 35 miles from St. Catharines.
But 10 weeks before her official due date, Coote's water broke as she was talking with her brother on the phone.
It was 4 p.m. Jan. 18.
She was first rushed to St. Catharines General, the nearest hospital, but it wasn't equipped to handle neonatal emergencies.
Coote and her husband, Dave, also 31, were getting ready to be transported to McMaster, which has a neonatal intensive-care unit, when they learned that the medical center was out of room.
"At first, I didn't know what they were talking about," Dave Coote remembered thinking. "No room? Where? No parking? And they said, 'We don't have beds available for the babies.'"
Mena Coote couldn't help but get upset.
"I'd been going [to doctors at McMaster] every other week for six months," she said. "They knew my situation. They knew everything about me. . . . I was scared. My contractions were coming like every 10, 15 minutes. I was getting nervous. [The twins] were coming soon."
Doctors scrambled to find another neonatal ICU in Ontario -- but all five major hospitals in the region were out of beds for babies.
The doctors were looking into flying Mena Coote by helicopter to Ottawa, without her husband.
Then they told the Cootes that as a last resort, they were looking into Buffalo's Women and Children's Hospital.
"Make that your first resort," Dave Coote told the physicians, "because it's a lot closer than Ottawa."
After running out of Canadian options, the doctors finally decided the Cootes needed to go to Buffalo.
The hospital called ahead to immigration officials to prepare the border patrol for Mena Coote's ambulance.
Dave Coote piled into a car with his wife's mother, sister and aunt and headed for the border.
"'Oh, my goodness. Go, go, go!' " a border agent told Dave Coote when he learned that his wife was in labor with twins.
Mena Coote arrived at Women and Children's Hospital at about 8 p.m. After being examined by the doctors, she underwent an emergency Caesarean section.
"I didn't know what to expect when we went over," said Dave Coote, who was pleasantly surprised by the Buffalo hospital. "The hospital care was absolutely fantastic. The neonatal care of Women and Children's was top of the line. It's very modern. They took very, very good care of us."
At 1:08 a.m. Jan 19, Henry James was born, weighing in at 2 pounds, 12 ounces. Two minutes later, his little sister, Alicia Marie, was born. She was 2 pounds, 6 ounces.
The moment they were born, the twins were U.S. citizens because they were born on U.S. soil. They also would be Canadian because of their parents' citizenship.
"I thought, 'Oh, they're really small,' but they were so cute," Mena Coote said of seeing her son and daughter for the first time. "I saw Alicia's eyes open, and I heard their little cries."
The babies stayed in Women and Children's for nine days -- and the Cootes and their families became celebrities at the border as they drove back and forth to visit the babies.
The babies were eventually transferred to McMaster and are now back in St. Catharines General, where they will likely have to stay another four weeks before they are strong enough to go home.
An Ontario Health Ministry official said that situations like the Cootes' are uncommon but have taken place "from time to time," especially in cases of extreme emergencies or highly specialized intensive care.
Michael P. Hughes, a spokesman for Kaleida Health, said its hospitals, which include Women and Children's, have seen a "incremental increase" of Canadian patients over the past year and a half.
"It's really for specialties, like orthopedics, cardiac, neuroscience," Hughes said.
The Cootes are still reeling over their ordeal but are thrilled that their little tykes will enjoy the benefits of dual citizenship.
"They were born U.S. citizens," Mena Coote said. "They'll be getting a New York State birth certificate. They got their Social Security number, and when they come out of the hospital, we have to get pictures taken and mail those in to immigration for them to get [Canadian] citizenship cards."
But mostly, the Cootes are just happy everything turned out all right in the end. Both the babies have gained a pound already and are breathing on their own.
"They're doing well," Dave Coote said. "We're doing feedings and cuddle times. We're just getting used to being parents."