From left, Aunt Lydia (Ann Dowd), Offred (Elisabeth Moss) and Janine (Madeline Brewer). Picture: George Kraychyk, Hulu

Proceed with caution. Contains spoilers.

When Wednesday's episode of Hulu's "The Handmaid's Tale" was emailed early to reporters last week, the screener came with a note: "Warning: this episode has content that may be extra sensitive for some viewers."

That wasn't a good sign, considering the acclaimed drama's content already features scenes of rape, torture and death in the authoritarian Republic of Gilead. But it turned out the warning was necessary: The episode included one of the show's most disturbing scenes ever, with the brutal rape of a nine-month-pregnant handmaid.

It started when June/Offred (Elisabeth Moss), the handmaid of Commander Fred Waterford (Joseph Fiennes) and Serena Joy (Yvonne Strahovski), appeared to go into labor. Obviously, the Waterfords were anxiously awaiting their child, as the only job of handmaids is to procreate and give the babies to rich couples. So the rituals began: Aunt Lydia and the handmaids gathered around Offred; the men celebrated together in the commander's study; and the wives surrounded Serena, who lay on the floor on a pillow like she was the one about to give birth.

But wait - false alarm. It was just Braxton Hicks contractions. Everyone packed up and went home, and Aunt Lydia snidely told Serena, "You might consider timing the contractions next time."

Serena was humiliated, and demanded that the doctor induce Offred immediately. When the doctor declined, explaining it's already a high-risk birth due to Offred's earlier bleeding, Serena became furious - especially because she could tell that Offred was glad the baby didn't arrive. So she brought up a suggestion to her husband: They should probably induce Offred "the most natural way."

Yes, it was exactly what you might have thought it meant: The common advice that sex can help induce labor. Serena summoned Offred to her bedroom. As Offred saw the commander taking off his jacket, she realized what was about to happen and started to panic. "No, please," she said. "You could hurt the baby. . . . Serena, listen to me. You don't have to do this."

"No, it's what's best for the baby," Serena said, as she pinned down Offred's wrists. Offred repeatedly screamed and tried to escape during the agonizingly long attack. It was an even more disturbing version of the already horrific monthly "ceremonies" - also known as ritualized rape - in which the handmaids lay in the laps of the wives and are forced to have sex with the husbands.

That was the point that the episode's writer, Yahlin Chang, said she was trying to make with the horrible scene. The "ceremonies" have always been rape. But the people in charge of Gilead seem to have convinced themselves that it's a completely normal way to conceive children. Usually, the handmaids are silent - as Emily/Ofglen (Alexis Bledel) thinks at the beginning of the episode, during a ceremony, "You treat it like a job. An unpleasant job to be gotten through as fast as possible. You steel yourself. You pretend not to be present, not in the flesh. You leave your body."

In this instance, the idea was for viewers to tell that the commander and Serena were not expecting Offred's reaction.

"They've done the ceremony a million times, and Offred's never fought back," Chang said. "Serena does not like realizing how brutal and terrible this actually is. She doesn't want to know truth of that, confronted with the truth that it's rape."

The idea for the scene came from what usually rules the decisions for the "Handmaid's Tale" writers, Chang said: Given these characters and these situations, what would really happen? In this case, the writers decided that Serena and the commander were so desperate for a baby, they would have done anything.

"The thing the OB always tells you is: 'Well, you can try and have sex and jog the process along.' That's a very natural thing, you know?" Chang said. "They don't see any problem with that because they've done this before."

Chang continued: "What I wanted to get across was for all those other ceremony scenes, it's like, what did you think was happening? The brutality of this scene is the brutality of everything handmaids suffer and continue to suffer every single month when they're raped. I wanted to get it to the truth of sexual assault."

As if that wasn't enough, the episode ends with the unbelievably heart-wrenching reunion between Offred and her daughter, Hannah. Normally, that would never happen in Gilead, but Chang said the commander felt so guilty ("at the very end of the ceremony ... it dawns on him what he did, and he feels terrible") that he arranged the meeting.

So all in all, this episode was extremely difficult to watch - and as some viewers debate whether they can psychologically handle keeping up with the show (especially in light of the current political era), what does Chang say to those who might have to quit after that disturbing scene?

"I do worry about people not wanting to watch because this was a very hard episode to watch. I have to say episodes 11 through 13 are just unbelievable. There's just this ramp-up adrenaline, momentous, amazing feeling," she said. "Especially the next episode right after this one, it's incredible. One of the best episodes of television ever."

Episode 10 did end up with quite the cliffhanger as Nick was kidnapped and Offred was stranded after her reunion with Hannah. "You have got to keep watching," Chang added. "There are amazing triumphs as well as huge upsets. I think people will really enjoy the next episode. ... It's really compelling what's coming up next. Please don't stop watching."