Well, the ending is somewhat open to interpretation, but there seems to be a general agree that what happens is that Alma rapes you at the end right before you pull that final switch. This is further strengthened by the fact that when she appears again, she appears to be somewhat pregnant, and that she makes you feel her stomach, just like a mother would. Yeah it's quite odd, but I do believe that's what happens. You can re-watch the ending below a few times to see if you think that's what's happening to.
http://www.youtube.com/watch?v=7hp-s6kPOlw

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