In an omegaverse where werewolves SOMETIMES have a male omega who can become pregnant, the idea in itself can be daunting. Even more so when the werewolf in question didn't expect to be anything other than an alpha.
This society's norms tend to parallel our real world, and thus the very idea of male with male is not accepted except in this very rare case, so the internal struggles of the protagonist, his unwillingness to accept himself and his role in this society, and the struggle for all the pack to find a balance - emotionally and as a pack - is long, hard, and full of pain. Even the obvious care the alphas feel for the omega takes a secondary place to the forced conditions of their genetics.
The principle problem is about choice. Informed choice. Impossibility to deny what society, or in this case, a cold hearted uncle-guardian, determines must happen, combined with instincts that seem to force those happenings, takes away all choice, negating the individual. Here, the very gritty struggle of that individual is excellently portrayed, taken to the point of virtual bondage.
The terrible moments, personal questioning, insecurities, and somewhat consequent horrible happening are so well written!
As an observer, beyond my own frequent tears of desperate frustration as a reader, the pain suffered by the protagonist was rendered in such a real way that it took quite a bit for my teeth to not be clenched in anger after finishing the story.
Definitely not for all readers, and the trigger warning offered by the author should be taken very seriously!