She assumed an integral role in the album's production and collaborated with several producers including Chad Kroeger, Stephan Moccio, Chris Baseford, Johan Carlsson, Lauren Christy from The Matrix, Ryan Cabrera, Travis Clark of We the Kings, Bonnie McKee, JR Rotem and Mitch Allan among others.

While some praised Lavigne's vocal performance, themes and maturity compared to the singer's previous works, some noted the "generic" sound of the album, criticizing the lyrics and production of certain songs.

[8] On March 1, 2017, Lavigne announced that she had signed with BMG Rights Management and promised to release the album in 2017.

[11] On August 18, 2018, Lavigne posted on her social media: "Exciting things coming" and "prepping for my video shoot".

[12] On September 6, 2018, Lavigne posted a letter to her fans on her official website, revealing she wrote and recorded most of the album on her couch due to Lyme disease.

[15] The front cover shows her nude sitting in a pool of water holding an acoustic guitar close to her body.

[14] In an interview with Entertainment Weekly, Lavigne explained that she "wanted to make this record about the vocals so you could really hear the lyrics and feel the emotion because sometimes the music can be overbearing", and to "explore with different sounds like "Crush" and "Tell Me It's Over"; they're a little bit more throwback and jazzy."

"[20] Third track "I Fell in Love with the Devil" is an "ominous, tightly crafted rumination on toxic relationships",[21] which Lavigne wrote "as a constant reminder to [herself] that some of the darkest people in this world can be disguised as angels".

About her inspirations to write the song, Lavigne said, "The vocals and the lyrics are very vulnerable which is reflective of the feelings I had in relationships like these.

I wanted to write something classic and have been inspired by some of the timeless queens I listen to everyday at home, Billie Holiday, Ella Fitzgerald, Aretha Franklin and Etta James.

[19] Eighth track "Crush" is "retro-leaning"[35] and "a warm ode to the more fluid moments of early love".

Ninth track "Goddess" "comes on with a playful note, wishing for a simpler time with breezy sonic flair",[36] while tenth track "Bigger Wow" was said by NME to "sound like a cross between Shania Twain and Sheryl Crow".

[19] Twelfth and final track "Warrior" is a ballad described by Lavigne as "one of the first songs I wrote for the album" and according to her, is "about the health battle I continue to fight every day".

[39][40] The song was described as "a powerful, spiritual epiphany detailing the Canadian singer's journey through her battle with Lyme disease.

[19] The album was also noted to show maturity compared to Lavigne's previous works; with Nick Levine of NME writing that Head Above Water "isn't her most banging album, but it is a deeply honest one that sounds a lot like growing up gracefully.

[57] In an article for Exclaim!, Ian Gormely observed that "Across the record's 12 tracks, Lavigne tries on a variety of styles, inhabiting each with ease, but rarely manages to rise above and make the sound her own".

[59] Dylan Tuck gave the album 2/5 stars in an article for The Skinny, acknowledging the powerful ballads such as the lead single, but negatively spoke about the majority of the album, noting that "it [felt] much like a lost Lavigne seeking a sound that’ll just keep her afloat".