Does current evidence justify or challenge the use of the “Fresh Eyes” approach for intrapartum fetal monitoring in maternity services? A scoping review

Background: The “Fresh Eyes” approach is widely promoted in UK maternity policy as a safety intervention to reduce error, support escalation and prevent avoidable harm in intrapartum fetal monitoring. National drivers have driven rapid implementation despite limited clarity about its empirical evidence base, creating a need to establish what evidence exists, how the approach is understood in practice, and where key gaps remain.

Methods: This scoping review followed Joanna Briggs Institute methodology and was reported in line with PRISMA-ScR guidance. Searches were conducted in October 2025 across six databases (MEDLINE, Embase, CINAHL Plus, Scopus, MIDIRS and PubMed) and supplemented by structured grey literature and citation searching. No language limits were applied. Two reviewers (MHP, DF) independently screened and extracted data using a purpose-designed charting tool. Data were analysed descriptively and mapped across domains of effectiveness, acceptability, feasibility and implementation, equity and accessibility, and psychological safety.

Results: 54 sources were included, comprising mainly policy documents, national reports, professional guidance, audits, quality improvement projects and qualitative or observational studies. No sources evaluated outcomes to test or demonstrate the effectiveness of “Fresh Eyes”. Most described it as a safety-support or governance process. Definitions and operationalisation varied widely, with heterogeneity in terminology, reviewer role, modality of monitoring, documentation and expectations. Evidence on acceptability was predominantly staff-focused, with minimal reporting of women’s or companions’ experiences. Feasibility was discussed in relation to staffing, workload and organisational culture. Equity, accessibility and psychological safety were rarely examined explicitly.

Conclusions: Despite strong policy endorsement, the “Fresh Eyes” approach is not supported by empirical evidence demonstrating effectiveness. It appears to function primarily as a governance and safety-culture intervention rather than a clearly evaluated clinical strategy. The literature shows substantial variation in implementation and a lack of rigorous evaluation of outcomes, equity and lived experience. Further research is needed to examine how “Fresh Eyes” operates in practice, whether it contributes to safer maternity care, and how women and birthing partner experience it.