Spoilers for This Is Us Season 5, Episode 7. Kevin pretty much blew up his whole life trying to get to the hospital in time for Madison to give birth, and he still might not even make it. He was in the middle of filming his movie in Canada, when Madison went into labor six weeks early. She's in Los Angeles, and even though Kevin left right that minute, he's still hours away. And if Kevin doesn't make it to see Madison, it could have a big impact on their relationship in a negative way.
Madison doesn't know this, but Kevin was on his way to the airport and would have been by her side in about four or five hours. But then he happened upon a car accident and took time to rescue the man trapped in his burning car. In the process, Kevin lost his driver's license at the scene. So when he showed up for his flight, he was unable to board. Literally saving a man is a really good excuse to not be there for the birth of your twins, but even still Kevin may not forgive himself.
"He has, his whole life, been bound by this idea that he wants to be what his father knew he could be," Justin Hartley told TV Line about his character. "Kevin doesn't give himself the breaks that maybe he should. He doesn't cut himself any slack. ... He puts a lot of stress and pressure on himself, and that sometimes can lead to the balloon popping, so to speak."
Missing Madison's labor might reinforce Kevin's fear of failure, even though he really did do everything he could — including jeopardizing his entire career by quitting in the middle of the film and screaming at the director on his way out. If Kevin is unable to forgive himself for possibly missing the birth, it could also get in the way of his relationship with Madison. He'll be too hung up on not being there to smoothly move forward into parenthood with her. And let's be real, she probably won't be able to immediately forgive him either.
Madison is a rational person, and she could potentially understand that Kevin did his best and also saved a man and that's why he couldn't be there. But with something as emotional as giving birth by yourself in the middle of a pandemic, rationale doesn't always factor in. Madison may understandably be upset that Kevin isn't there and she may not be able to look past it, even if she logically knows it's not Kevin's fault.
And while Madison did encourage him to go to Canada to film the movie, she also told him to think about how she and their kids would fit into his career going forward. She made it clear that she didn't love the travel aspect of his job, and since him traveling for work is why he couldn't rush to the hospital to be with her, she may harbor resentment. That will only make their relationship more complicated.
There are a lot of theories that Kevin and Madison aren't endgame, and creator Dan Fogelman didn't provide any reassurance when he spoke to Deadline ahead of the Season 5 premiere. "It's not just going to be this easy love story like some of our other love stories have been," he said. "They have an up-and-down journey ahead of them." Kevin missing the birth of his children will almost certainly bring about a "down." And considering that both Kevin and Madison will likely be crushed by that, there may be no climbing out of this relationship low.