Methods: ACTES is a single-centre exploratory naturalistic study conducted at Strasbourg University Hospitals (France). Women with childbirth-related traumatic stress were treated within one of three a priori care pathways defined by the timing of EMDR initiation: immediate postpartum (in-hospital Recent Traumatic Episode Protocol, n = 8), early postpartum (1–12 months, standard 8-phase EMDR, n = 8), or late postpartum (> 12 months, standard 8-phase EMDR, n = 8). A baseline PCL-5 score ≥ 30 was used to define probable PTSD. The PCL-5, Edinburgh Postnatal Depression Scale (EPDS), and Subjective Units of Disturbance (SUD) were collected pre-treatment (T0) and at 1, 6, 12, and 18 months post-treatment (T1–T4). Reliable change between T0 and T1 was estimated using the Reliable Change Index. Post-treatment trajectories were modelled with non-parametric mixed-effects models based on the Aligned Rank Transform.

Results: Of 36 women included, 24 (67%) completed treatment and all four post-treatment assessments. Baseline symptom burden was high (median PCL-5 47.0; SUD 9.0; EPDS 13.0). 20 of 24 women (83%) showed a reliable PCL-5 improvement at T1. 15 of the 20 women initially above the PCL-5 cut-off (75%) crossed below the threshold at T1. Whole-sample median scores remained below baseline at 18 months (PCL-5 12.0; SUD 2.0; EPDS 4.0). In T1–T4 models, only the time effect on SUD reached significance (F(3, 66) = 3.03; p = 0.036); no group effect or interaction was detected.

Conclusions: These exploratory observations are consistent with the clinical feasibility of an integrated EMDR care pathway across three timing windows in a tertiary maternity setting. The small sample size and the absence of a comparison condition preclude any conclusion regarding the comparative efficacy of intervention timing or protocol; confirmatory trials with adequate statistical power are required.”