By: Ashleigh Austel

Published On: May 17, 2024

When Henry Ford invented the moving assembly line in the early 1900s, it revolutionized the manufacturing industry.[1]  In the 1970s and 1980s, business and management schools began circulating the idea of an assembly line model in hospitals.[2]  The idea behind the model was that if hospitals could replicate a manufacturing style in caring for and discharging patients, they could save money and provide care to more patients.[3]  Hospitals have implemented this model, and the opposite has proven true, particularly in the maternity ward, and particularly for Black birthing people.

The United States has one of the highest maternal mortality rates among developed countries.[4]  In 2020, there were 23.8 maternal deaths per 100,000 live births; the next highest industrialized country was France, with a rate of 8.7 maternal deaths per 100,000 births.[5]  Furthermore, Black people and birthing people are three times more likely than white people and birthing people to be at risk of mortality during pregnancy and childbirth.[6]  There are, of course, many factors that contribute to this statistic, including systemic racism and discrimination.  Another major contribution, however, is an institutional failure within the healthcare system, namely the moving assembly line model.[7]

Hospitals began implementing the moving assembly line in healthcare to reduce the amount of time doctors spend with patients and thereby decreasing medical costs.[8]  However, the assembly line model in patient care and discharge has caused medical costs to increase and patient care to plummet.[9]  “When hospitals are factories and hospitalists are assembly line workers it follows that patients can easily become widgets.”[10]  This has proven especially true in labor and delivery.  It is not a coincidence that the rate of Cesarean deliveries, or C-sections, has increased 500 percent since the 1970s, around the time the moving assembly line was implemented in hospitals.[11]  One in three babies in the United States are now born via C-section.[12]  As with maternal mortality rates, people of color bear the brunt of the risk when it comes to C-sections.  A 2020 study found that race and ethnicity was a significant factor in determining how likely a laboring person was to receive a C-section.[13]  Black and Asian people were more likely than white people to receive a C-section.[14]

The assembly line model focuses on moving patients from the waiting room to discharge as quickly as possible.  When a pregnant person has labored for more than twenty hours, they are in “prolonged labor,” and most doctors will recommend a C-section.[15]  However, laboring for more than twenty hours does not necessarily mean a C-section is warranted.  In 2014, the American College of Obstetricians and the Society for Maternal-Fetal Medicine released guidelines advising doctors to allow people to labor longer before concluding a C-section is necessary.[16]  The guidelines recommend allowing people to push for at least three to four hours before considering a C-section.[17]  The guidelines further instruct that the timeframe considered “early labor” should be extended so that “active labor” begins when the cervix is dilated to six centimeters instead of four.[18]  Despite these recommendations, the number of C-sections has not decreased over the past 10 years; in fact, it has increased.  In 2014, the rate of C-sections was 22.3 percent; in 2021, the rate of C-sections was 32.1 percent.[19]

In theory, the moving assembly line model was meant to cut healthcare costs and improve patient care.  Instead of manufacturing better healthcare, the assembly line model has manufactured a spike in C-sections and maternal mortality, which has been borne on the backs of people and birthing people of color.  The hospital assembly line experiment of the 1970s has failed.  It is time for hospitals to begin dismantling the institutional racism and discrimination this failed experiment has caused.   The American College of Obstetricians and the Society for Maternal-Fetal Medicine began moving towards a solution in 2014 when it recommended that doctors wait longer before performing C-sections.[20]  Hospitals can work towards a resolution to the failed experiment by taking these recommendations seriously and requiring doctors to implement a longer waiting period before conducting C-sections.

[1] The Moving Assembly Line and the Five-Dollar Workday, Ford, (last visited Feb. 9, 2024).

[2] Arthur H. Gale, The Hospital as a Factory and the Physician as an Assembly Line Worker, 113 Mo. Med. 7, 7 (2016).

[3] Id.

[4] Jamila Taylor & Anna Bernstein, The Worsening U.S. Maternal Health Crisis in Three Graphs, The Century Foundation (May 26, 2023),

[5] Id.

[6] Id.

[7] See Kathy Katella, Maternal Mortality Is on the Rise: 8 Things To Know, Yale Medicine (May 22, 2023),

[8] Gale, supra note 2, at 7.

[9] Id.

[10] Id. at 9.

[11] Better Off, The surprising factor behind a spike in C-sections, Harvard T.H. Chan School of Public Health (July 27, 2017),

[12] Id.

[13] Ijeoma C. Okwandu et al., Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women, 9 J. of Racial & Ethnic Health Disparities 1161, 1169-70 (2022).

[14] Id.

[15] Prolonged Labor: Failure To Progress, American Pregnancy Association,,the%20first%20stage%20of%20labor. (last visited Feb. 9, 2024).

[16] Nancy Shute, Doctors Urge Patience, And Longer Labor, To Reduce C-Sections, NPR (Feb. 20, 2014, 4:47 PM),

[17] Id.

[18] Id.

[19] Cesarean Birth Trends in the United States, 1989–2015, National Partnership for Women and Families (2017), chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/; Births – Method of Delivery, Centers for Disease Control and Prevention, (last visited Feb. 9, 2024).

[20] Shute, supra note 16.

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