Carrie Underwood says her facial injury made it "physically impossible" for her to sing for part of last year.
The 35-year-old country star and former "American Idol" winner said in an interview with Vulture published Thursday that she struggled to record her album Cry Pretty after getting more than 40 stitches in her face following a fall at home.
"I had wanted to be in the studio sooner than I was, actually recording these songs, but I had stitches inside my mouth, outside my mouth. It was physically impossible," Underwood recalled.
"Going into the studio for the first time, it was a mind game: 'Do I sound the same? Is my diction the same? Does my mouth move the same as it did before?'" she said. "My m's and b's and p's were kind of the issue."
Underwood released Cry Pretty in September after injuring her face and wrist in November 2016.
She said she drew on painful personal experiences, including her injury, while writing the album.
"It would be completely inevitable. I'd have a terrible day at the doctor's office and then come into a writing session and be like, 'I'm sorry guys. I might suck today. I just got some bad news,'" the star said.
"Things aren't literal, but I look at a song like 'Low,' and that was my year last year," she added.
"I listen to that song now, and there's a good chance I'll cry, because it was just so personal."
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In addition to her injury, Underwood went public in September about having three miscarriages in 2017 and 2018.
The singer is expecting her second child with her husband, former NHL player Mike Fisher.