Inspiration for My Debut Novel

Nikki Smith

What inspired my debut novel?

PD James said ‘All fiction is largely autobiographical.’ I don’t think that’s true, but I do think first novels sometimes contain an element of this – often in the similarities between the author and their protagonist.

My debut novel, All In Her Head (and there are spoilers here, so don’t read on unless you’ve read it!) focuses on a woman suffering from post-partum psychosis. I didn’t suffer from this particular condition or consciously choose the subject because of my own experience, but after I’d finished writing it, I realised the fictional story about a woman who suffers from this condition was probably subconsciously a way of working through some of the trauma I went through after giving birth.

I had my second daughter in 2007, over ten years ago. She was an unexpectedly large baby at 9lb 9oz (I’m only 5ft 3) and I ended up in intensive care for several days after being rushed into theatre – I’d haemorrhaged as a result of an undiagnosed placenta accreta and lost over three litres of blood and needed several blood transfusions. I’d had a retained placenta after
having my first daughter a couple of years earlier and that should really have highlighted that I was at higher risk for another, but for whatever reason, it was never picked up.

At the time, I didn’t appreciate the mental trauma I’d suffered as I was too busy trying to recover physically in order to look after a new baby also my toddler who was just turning two. I attempted to carry on as if everything was normal and present an image to everyone else that I was fine, but actually I felt very tearful most of the time and certainly didn’t feel that instantaneous overwhelming sense of love for my daughter that other seemed to feel (and that I’d had with my first child). I suffered from flashbacks and difficulty sleeping, but still insisted I was fine. I was lucky; over the following months I healed; I began to sleep better, bond with my daughter and had fewer flashbacks.

When I started writing the novel that eventually became my published debut, and began to think about my characters and plot, I read some articles on post-partum psychosis and
became fascinated with the subject. I was shocked this condition affects 1 in 1000 women when they give birth and many people are still completely unaware of it. I also found it terrifying that the process of having a baby, something that we consider to be natural and normal, can change a woman’s mental state so fundamentally that they are unable to comprehend what is reality and what isn’t; a situation that can on occasion, sadly, end in
horrendous tragedy.

Most people have heard of women such as Andrea Yates who drowned her five children in the bath, but it should be stressed that such tragic outcomes are rare, and also preventable if they are identified in time. In all the cases that I researched, no mother ever intended to hurt her baby – in fact the exact opposite was true – the mother’s over-riding desire was to protect their child, but the delusions they were suffering from meant it was how they went about trying to do this that resulted in tragedy.

Although I didn’t suffer from post-partum psychosis, some of the feelings Alison has in the book made her, for me, an easy character to write. I think subconsciously she’d been in my
head for a long time – hence the idea for the title of the book. Writing about a fictional character gave me a chance to work through some of the more upsetting aspects that haunted me after giving birth – the lack of control over the birthing process, the horror of a traumatic birth, the feelings of isolation that I had afterwards, separated from close family by physical

When writing All In Her Head I wanted to highlight not only this extreme condition, but the fact that in the UK (and other countries in the developed world), women are often shielded from the dangers of giving birth. ‘Natural births’ are encouraged, and many women feel like a failure if they don’t achieve a birth without pain-relief, if they can’t breastfeed, if they end up with a cesarean.
No one likes talking about the potential dangers that can result from having a baby that many women are unaware of. In the UK, 67 women died in 2018 childbirth or as a result of complications arising from pregnancy. Women over forty are three times more likely to die compared to someone in their twenties. Less serious, but still incredibly traumatic are the consequences of living with long term conditions largely caused by pregnancy or childbirth
such as urinary incontinence (affecting up to 1 in 3 women) and pelvic organ prolapse (reported by 1 in 12 women).
And these are just the physical issues. Mental trauma is even more prevalent. 1 in 10 women will suffer from some form of post-natal depression; I’m sure I did, but it was undiagnosed,
probably because I insisted that everything was ‘fine’ when it wasn’t; ticking the ‘right’ boxes on a form I was given by a visiting midwife because I didn’t want to make a fuss. I hope by writing the book, it will make people more aware of these issues surrounding childbirth.

My second novel, Look What You Made Me Do is published in April (lockdown launch II for me – I’m beginning to feel like a pro!!) and I don’t think I have anything in common with the characters in this one – but it will be interesting to see what readers think – perhaps there is a small part of the author somewhere in every book they write.

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