Queen Mab by Emily McBride: When motherhood becomes a fairy tale nightmare

What if the greatest horror isn’t that you’ve lost your mind—but that you’re the only one seeing the truth? Emily McBride’s Queen Mab follows twenty-three-year-old graduate student Madeleine, whose carefully planned future is upended after a traumatic childbirth ends in an emergency C-section. Instead of bonding with her newborn daughter, Maud, Madeleine becomes convinced that the baby has been stolen by the faeries and replaced with a changeling. As her husband, parents, and medical professionals dismiss her growing fears, Madeleine desperately searches folklore and literature for a way to bring her real child home.

This is now the third novel I’ve read in recent weeks that explores the aftermath of traumatic childbirth, and I’m definitely noticing a trend. The other two were Good Morning Means I Love You by Kendra Allen and With Friends Like You by Amy Chozick. These are three very different novels examining the same important subject from very different perspectives, and I love seeing contemporary fiction finally giving serious attention to what can happen after childbirth instead of treating birth as the tidy ending to a woman’s story.

Of the three, Queen Mab comes closest to my own experience. Like Madeleine, I had planned for a natural childbirth only to end up with a surprise C-section. In my case, I learned two weeks beforehand that my son was breech and wasn’t going to make it safely through the birth canal. Even with those two weeks to mentally prepare myself for the change in plans, I still found the experience traumatic. Madeleine has no such opportunity. After enduring hours of agonizing back labor, she is suddenly told that surgery is necessary. One moment she believes she’s about to give birth naturally, and the next she’s being wheeled into an operating room. That difference matters.

I’ve often thought that mental preparation is one of the biggest factors in how well someone recovers psychologically from childbirth. Birth is inherently traumatic. Every woman experiences physical trauma, but not every mother develops PTSD, postpartum depression, or postpartum psychosis afterward. Brain chemistry, hormones, previous mental health history, genetics, and the amount of support available after leaving the hospital all play important roles. Queen Mab asks an equally fascinating question: how much of what Madeleine experiences is uniquely hers, and how much is rooted in something universal about motherhood itself?

The novel also explores questions of family through Madeleine’s relationship with her adoptive father. Throughout the story, he becomes increasingly obsessed with genealogy and DNA testing, searching for biological relatives and ancestral connections. Madeleine can’t help feeling wounded by his fixation. She knows she isn’t biologically related to him, and every new family discovery seems to reinforce the importance of blood over choice.

The timing makes his obsession feel even more painful. When Madeleine gives birth, her adoptive mother travels to visit while her father delays his trip to continue pursuing another genealogical lead. He does eventually join them, but Madeleine understandably struggles with the feeling that meeting his new grandchild—whether related by blood or not—should have mattered more than chasing another distant branch of his family tree. I found myself agreeing with her. The novel raises thoughtful questions about what truly makes a family and whether shared DNA should ever outweigh the relationships we’ve intentionally built.

McBride also captures something that I think many fathers—and society as a whole—often fail to understand about early motherhood. Tom is, by most standards, a supportive husband. He loves his wife. He loves his daughter. He helps when he’s home. Yet he still doesn’t really see Madeleine.

She has spent months growing an entirely new human being inside her body before undergoing major abdominal surgery to bring that child safely into the world. A few short days later she’s expected to recover physically, regulate overwhelming hormones, feed an infant around the clock, and somehow instinctively know how to be a mother. Babies don’t come with instruction manuals, yet new mothers are somehow expected to be the instruction manual.

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Even the health visitor who checks up on the new baby at home after the birth seems more interested in enjoying the cookies Madeleine has set out than in honestly asking how this exhausted young mother is doing. Everyone checks on the baby. Almost no one checks on Madeleine. That lack of truly seeing her becomes devastating.

Madeleine gradually convinces herself that she accidentally allowed the faeries to steal Maud by leaving her hospital window open overnight. She researches changeling folklore obsessively, desperate to discover how she might retrieve her real daughter. Yet despite her increasingly erratic behavior, the people around her continually miss how serious her condition has become. It isn’t until she casually walks into her grandparents’ house wearing only her underwear after abandoning the rest of her clothes beside a stream that everyone finally realizes something is terribly wrong. By then, the consequences could easily have been catastrophic.

Considering that Madeleine spends most days caring for a newborn completely alone, the failure to recognize the severity of her psychotic break becomes one of the novel’s most unsettling observations. Mental illness doesn’t always announce itself dramatically. Sometimes it develops slowly enough that the people closest to us normalize behaviors that should have been warning signs all along.

One of the novel’s greatest strengths is how skillfully McBride maintains uncertainty throughout the story. Although readers intellectually understand that Madeleine is almost certainly experiencing postpartum psychosis, the narrative occasionally plants just enough doubt to make us wonder whether she could actually be right. Could Maud really be a changeling? Could the old fairy stories contain truths that modern medicine has forgotten? That uncertainty places readers inside Madeleine’s mind in a deeply unsettling way. Her conviction becomes our own, if only for a moment, making her terror feel immediate and completely authentic.

As someone with an academic background herself, McBride also fills the novel with literary references that feel entirely organic. Because Madeleine studies Victorian and Modernist literature, the allusions emerge naturally through her thoughts rather than feeling like an author showing off. Readers familiar with the works being referenced will appreciate the additional layers of meaning, while those without that background can easily enjoy the story without feeling excluded from the conversation.

Queen Mab is a beautifully written literary novel that blends psychological horror, folklore, and family drama into an emotionally devastating portrait of new motherhood. It offers no easy answers about postpartum mental illness, genetics, or family bonds, but instead invites readers to sit with uncomfortable questions about identity, perception, and the stories we tell ourselves to survive trauma. For anyone interested in literary fiction that examines motherhood with honesty, compassion, and just a touch of the uncanny, this is a novel well worth reading.

An advance reader copy of this book (ARC) was provided to me by the publisher via Netgalley in exchange for an honest review.

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For fans of We Need to Talk About Kevin, The Push, and Baby Teeth.