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A grown-up Jack Damon lies with his wife, concerned that she hasn't gone into labor yet. He gets his guitar and sings for her. 

Meanwhile we see some people in a stable and a woman turning a guy at an art gallery down for a date. He asks about her famous one-night stand -- who is he?

Lucy goes into labor.

In the past, Jack Sr wants to have sex with Rebecca on the Big Three's birthday but are interrupted by crying babies.

Kate and Rebecca make a cake for baby Jack's first birthday. Toby says that there is a special surprise for Jack tomorrow. No one is listening.

Kevin calls Nicky. He says he got his gift for Jack. Nicky says he can return it and get something better. He goes on about their are billboards of Kevin all over town that make him laugh. Kevin tells him that he is one year sober tomorrow on Jack's birthday.

Beth tells Randall she isn't sure abuot the clinical trial and doesn't approve of what he did to get Rebecca to agree. Meanwhile, DEja will miss Malik while she is away.

Lucy wonders about names -- Abigail for a girl? The nurse lets slip that they will be having a girl.

Music plays at Jack's birthday party. Randall seems to be off to the side during a montage, which also includes scenes of the Big Three's first birthday, which Jack takes a movie of. Baby Randall cries and doesn't like the cake. Rebecca cries.

In the present, Kevin is left alone with Randall and Beth. Beth goes to get some cake and give the guys privacy. Kevin says he knows Randall did a lot of research on the clinical trial but he wants him to know where he's coming from. Mom is in a good place and here with her family and that's what she wants. He walks off. Randall congratulates him on his one year sober.

Randall approaches Rebecca, who says she has an announcement. Beth hurries away. She says she and Miguel have been doing research and she has decided to do the clinical trial. Kevin and Kate are upset. Randall says they will come visit her and hugs her.  Kevin asks Rebecca if this is what she wants. She says hes and he hugs her too. Miguel looks upset.

We see the guy with the horse again. His daughter shows up. Her name is Sadie. She seems to have a way with the horse.

The art gallery curator talks about the way the artist uses color. She gets a text and asks Zach to cover for her. SHe won't say where she's going.

Kevin and Kate don't get why Rebecca changed her mind. Kevin asks if she said anything to Randall. He says she just sees it as an investment in her future. The others tease him about being weird. Toby announces he and Kate have a special thing just for the three of them. Nobody cares.

Rebecca admits to Jack that she's thinking about the baby they lost -- Kyle -- and what his firsts would have been like. They don't ever even see his name. She can't even watch home movies from when she was pregnant. Jack says he thinks about him too. He didn't know if there was something they were supposed to do, just that thinking about Kyle made him feel sad. He suggests they go for a ride. They go to see Dr. K.

Lucy is in labor.

Kate and Toby take Jack to the NICU  They put a photo up on a bulletin board to show how their preemie has grown. Jack feels the picture. Kate finds it strange to b e back. Toby asks if she remembers waking up after the C-section. She doesn't really.

In flashback, Toby tells her that it's a boy. Kate wants to know how big he is. oby tells her and says the baby is here and so is he. In the present, he apologizes to Kate for not being the best version of himself. He says Kate's life is defined by family. He thinks Jack deservves that too. Doesn't she think he deserves a sibling? Kate says she can't get pregnant again with all the complications and risks. Toby says he knows, but don't the Pearsons have a good track record with adoption?

Dr. K talks to Jack and Rebecca about how he lost his first child too. He used to sing Blue Skies when his wife was pregnant. He sings it now. He says after they lost the child he and his wife listened to the song on their record player over and over and it made them sad. It was like they were punishing themselves. But then his wife got pregnant again and he started singing that song again. He danced with his daughter to that song at her wedding. He talks about how hospitals are places where you experience joy or tragedy while Jack and Lucy meet their baby. Dr. K thinks you shouldn't keep the joys and tragedies apart.

Kate thinks adoption is too much of a risk. Will Toby even want this once they leave the parking lot? Toby says probably not. THey leave the parking lot and Toby says he still wants another child. Kate does too.

The art gallery person turns out to be Jack Damon's sister who is excited to meet her niece. 

Sadie keeps working with the horse, who she says wants to run and that he hasn't had a chance to be himself yet.

Sadie's father goes to his office. He turns out to be an obsetrician. His patient (Madison?) can't believe she is actually pregnant when she was told she couldn't have children. The doctor wonders why she is alone. She says she hasn't told anyone. The only thing she knows is the father wouldn't want this because he comes from a long line of love stories.

Kevin goes to talk to Rebecca who says they were about to show the girls Hollywood Boulevard. Kevin says he is surprised about her decision. Rebecca says when she started to think about it she had a change of heart. She says she views it as an investment in her future.  Kevin realizes what happened and storms off. Beth convinces Rebecca to get Miguel and the girls and go.

Kevin confronts Randall, who denies everything. Kevin doesn't accept that. Randall gives him a non-answer. Kevin accuses him of not letting Rebecca side with him. Radall starts to walk away. Kevin follows him and grabs him. He says Randall didn't care about what she wanted or needed. Madison shows up. Randall takes off. Madison says they need to talk. KEvin doesn't see what they need to talk about. Madison tells him she's pregnant and he's the father. She's sorry. But she's going through with this. It's a miracle she's pregnant. But she will ask nothing of him. KEvin stares at her. He says he's not walking away but needs a minute. He walks out. Randall accosts him and accuses him of being selfish. Kevin says this is about Randall.  Kevin says where the hell did this narrative come from? If he was there he would have saved Jack. Randall says Jack died ashamed of Kevin.He says Kevin caring about anyone is just a tired, stale performance.  Kevin says the worst thing that ever happened to him was them bringing Randall home.  Randall just goes. Kevin gets a text. It's from Nicky congratulating him.

Cassidy comes to take Nicky to a meeting.

Sophie sees Kevin's billboard.

Kevin comes back to Madison. He says he's tired of doubting himself and is all in.

In the future, Kevin and Randall look at each other at Rebecca's deathbed, and Nicky hugs Kevin.

Madison tells Kevin it's twins. In the future he has a boy and a girl

Jack's sister asks what the baby's name is.

In the past, Jack and Rebecca look at video of when she was pregnant.

Kevin touches Randall's shoulder at Rebecca's deathbed.

Jack D. says the baby's name is Hope\

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This Is Us Season 4 Episode 18 Quotes

Kevin: Listen, I got to get into this meeting. But tomorrow is my one-year-sober. My one year sober is also Jack's birthday.
Nicky: Oh.
Kevin: I thought you might want to congratulate me.
Nicky: I'll congratulate you tomorrow.

Jack. That song is amazing. So amazing that I'm having contractions.