While most breech babies are delivered by caesarean section, a small number are born vaginally. Detailed counselling and an accoucher skilled in vaginal breech birth (VBB) are essential for offering the modality. External cephalic version (ECV) is safe, acceptable to most women, has few contraindications and increases vaginal birth rates. Undiagnosed term breech presentation can largely be prevented by routine third-trimester ultrasound.Research is needed to evaluate the efficacy of VBB simulation training in clinical practice. Learning objectivesTo understand the evidence base around breech presentation at term, including ECV, VBB, caesarean section and adjunctive methods of cephalic version. To understand the prerequisites for, and contraindications to, VBB.To understand the principles of physiological breech birth.To appreciate the variation in management of term breech presentation internationally and understand the impact of various publications. Ethical issuesWith falling rates of VBB, and many units now unable to offer the modality, questions surround the appropriateness of national guidance continuing to present vaginal breech as routine. Conversations around breech birth isolate discussion of risk to the fetus. Maternal risk, which may extend beyond the current pregnancy, cannot be overlooked.