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Hill conceived the pregnancy metaphor while listening to Megan Thee Stallion's completed guest verse on his track "Dolla Sign Slime." In subsequent interviews, he explained that his stylist jokingly suggested he looked like an expecting mother nursing a secret project. Instead of dismissing the remark, Hill recognized an opportunity to stage a conceptual theatrical performance.

Releasing a debut album after the historic diamond success of "Old Town Road" carried immense commercial pressure. Critics wondered whether Hill possessed the stamina to produce a cohesive full-length record or if his success was merely a novelty. Treating Montero as a literal child under development allowed Hill to poke fun at his own creative anxieties while commandeering the news cycle. The 15-track tracklist, anchored by hits like "Industry Baby" featuring Jack Harlow and the boundary-pushing title track, became the centerpiece of a nine-month metaphorical gestation period.

The stunt formed a creative bridge between audio and narrative theater. Hill framed the artistic process not as a sterile studio schedule, but as a grueling, vulnerable, and ultimately joyful birth that demanded his full emotional investment.