The Pitt hasn’t shied away from realistic — and often graphic — medical procedures.

When Max dropped the March 13 episode of the Noah Wyle-led medical series — which has already been renewed for a second season — fans were blown away by its hyper-realistic depiction of childbirth. In an episode titled, “5:00 P.M.,” a woman named Natalie (Enuka Okuma) is wheeled into the emergency room.

Other medical dramas have often depicted childbirth, but not to this level of graphic detail. Series creator R. Scott Gemmill told Vulture that the show’s commitment to accurate medical portrayal is one of The Pitt‘s core purposes.

“It’s really being cognizant of the reality of the medicine, trying to stick to it, trying to present it as authentically as possible,” he explained. “That’s why we’re doing it this way: not to cheat it.”

Director Quyen Tran agreed with Gemmill’s sentiments and revealed to the outlet that her own personal experience with childbirth was a driving force in portraying birth without any cuts.

“It was really important that I was able to film the baby coming out and then tilt up to the mother so it’s all connected. And at the same time, how do we film it in such a way that we don’t see all the off-camera support?” she recalled. “I was very invested in making this as authentic as possible, because I had lived it.”

The Pitt eventually achieved its goals by using a custom rig that included a gurney with a silcone prosthetic of a pregnant belly, legs and a vaginal canal anchored on top of it. Directly behind the rig is a chair the actress sat on, and when it was time to shoot the scene, she leaned over the prosthetic and aligned herself with the belly.

Her actual legs were hidden by the gurney and other medical draping. That draping also hid two separate puppeteers who crouched in-between the chair and the rig. One puppeteer added blood and other fluids during the scene through a tubing system while the other placed their arm inside the hollow belly to push the fake baby out of the vaginal canal.

Despite making a few adjustments, like matching the prosthetics to Okuma’s skin tone and reshaping the belly, she and Tran still needed to make a few changes to prioritize Okuma’s comfort.

“I got in the rig and it didn’t feel great, because the chair didn’t allow the perfect marriage of the prosthetic with the actress. So we made adjustments,” Tran recalled. “Round two, she got in and it still wasn’t right with the seat. She wasn’t comfortable, she couldn’t hold herself up,”

Because she knew the scene was going to be “mentally exhausting [and] physically exhausting,” Tran devised a plan to use a kneeling-style chair in order to give Okuma more support when she leaned over the prosthetic.

Okuma was also given an intimacy coordinator, even though the body on the gurney was a silicone model.

“Everyone understood it wasn’t me, but it’s still a vulnerable position to be there, with people kind of gawking,” Okuma explained. “I really, truly appreciated it. Even though we all know it’s make-believe! It’s just, ‘Let’s make this actress comfortable.'”

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The Pitt releases new episodes every Thursday on Max.