Warning! The following contains spoilers for Grey's Anatomy**'s "Silent All These Years." Read at your own risk!**
Grey's Anatomy's heartbreaking consent episode was one of the series' most powerful episodes in quite a while, and it almost didn't happen as intended. It turns out ABC initially took issue with some of the imagery the episode contained, and preferred it be removed from the episode. Showrunner Krista Vernoff said Shonda Rhimes pushed back, and fought for the right for the episode to film as scripted:
We received notes initially from ABC's Broadcast Standards and Practices. They give these standard notes: 'don't be too gory'; 'don't be too explicit in your language'; 'no side boob.' But the ones we got on this script included, 'Please don't show any fluid on the Q-tips' and 'Please don't show any body fluids under the blue lights.' Shonda wrote back a pretty passionate response of the myriad ways that networks are willing to show actual violence but that what we were doing here was the medical process that happens in the wake of violence and they were trying to tell us we couldn't show it. She said, 'Respectfully, I decline these notes.' that ultimately ABC understood that she was right. I really give them credit that they came back and said, 'You're right. You can proceed as scripted.' We then extended the invitation to that ABC Broadcast S&P executive to be part of the wall of women and she came.
Much of ABC's initial complaint involved the plot in the hospital, in which a woman came in with several horrific injuries. It was from a sexual assault, but the woman was initially afraid to admit. After some encouragement from Jo and others, she submitted to the tests, which involved a rape kit and some of the processes ABC initially saw issue with. Luckily, they ultimately changed their minds, and the episode ran as aired.
Surprisingly, the episode was one that its writer, Elisabeth Finch, had pitched for a while. The concept was built around the scene in which the women of the hospital lined the halls in support of a rape victim, but Vernoff and Finch told THR the pitch never worked organically into an episode. It wasn't until the decision was made to flesh out Jo's origin that it could run.
As it turned out, Jo found her biological mother and learned the truth behind her abandonment. Her mother had been raped, and while she was numb the nine months of her pregnancy, she realized she couldn't look at Jo without seeing her rapist as well. The news was tough for Jo to swallow, and the meeting between her and the mother ended without any happy closure, but Jo's actions at the hospital prove she understood the trauma her mother felt to a degree.