Planned vaginal breech delivery: should this be the mode of choice?

Key content The risks of serious early perinatal morbidity and mortality are three times higher for planned vaginal breech delivery than for elective caesarean section. Because morbidity and mortality are relatively low, a large number of caesarean sections needs to be performed to avoid a single adverse event. External cephalic version appears to be a safe procedure that can halve the number of breech presentations but the procedure is not risk‐free. Four guidelines or directives are outlined but need to be adapted to the setting in which they are applied. Planned vaginal breech delivery is an acceptable choice to offer, provided strict protocols are followed. Learning objectives To gain an awareness of the risk factors and benefits of external cephalic version. To gain an awareness of the short and long‐term risk factors and benefits to the mother and child of planned vaginal breech delivery compared with elective caesarean section. To be able to manage breech presentation at term in different clinical and in differently resourced settings. Ethical issues Can planned vaginal breech delivery be justified? How can expertise in vaginal breech delivery be learned or taught if a policy of elective caesarean section is implemented? How can we obtain genuine informed consent when there are so many areas of uncertainty for degree of risk and benefit? Please cite this article as: van Iddekinge B. Planned vaginal breech delivery: should this be the mode of choice? The Obstetrician & Gynaecologist 2007;9:171–176.