Background: Accurate interpretation of cardiotocography (CTG) during labor is essential for identifying potential fetal compromise and supporting timely clinical decision-making. The Fresh Eyes approach uses collaborative CTG review by a second clinician as an additional safety process to support interpretation and escalation. Objective: To evaluate sustained compliance with the Fresh Eyes approach to CTG review and describe neonatal outcomes, particularly clinically confirmed hypoxic-ischemic encephalopathy (HIE), in a Labor and Delivery unit. Methods: A quality improvement study was conducted over 13 months, from July 2024 to July 2025. Eligible CTG records of mothers in active labor at ≥27 weeks' gestation were audited using an approved Fresh Eyes compliance checklist. Monthly compliance with core process indicators and neonatal-outcome capture within the audit was assessed descriptively. Delivery volume and clinically confirmed HIE cases were also monitored. Results: A total of 1,198 CTG records were audited. Compliance with Fresh Eyes review within 1–2 hours, documentation of clinicians' signatures and badge numbers, and documentation in BESTCare remained at 100% throughout the monitoring period. Neonatal outcomes were captured within the audit in 1,068 records (89.1%). Among 1,683 deliveries, five clinically confirmed HIE cases were identified, corresponding to 3.0 cases per 1,000 deliveries. Because Fresh Eyes compliance showed no variability, an association between compliance and HIE occurrence could not be statistically evaluated. Conclusion: The Fresh Eyes approach demonstrated sustained feasibility as a structured collaborative CTG review process. Continued monitoring of interpretation quality, neonatal-outcome capture within the audit, and multidisciplinary review of adverse outcomes is warranted.