Breech presentation is associated with significantly increased risk of perinatal morbidity and mortality. Most of the morbidity and mortality associated with breech delivery results from cord compression, nuchal arm, and difficulty in the delivery of the aftercoming head. Routine cesarean delivery of term breeches may not be an unreasonable option, according to many physicians. In our view, the best results for vaginal delivery are achieved using strict protocols that select term or near-term frank breeches of normal size and with proper demonstration of pelvic dimensions. Serious consideration for cesarean delivery should be given to all others. If cesarean delivery is chosen for the very low-birth-weight infant, it is important to use a vertical uterine incision and appropriate anesthesia techniques to ensure atraumatic delivery and optimize out-come. ECV is safe and effective for reducing the incidence of breech presentation but will have little, if any, impact on the overall cesarean delivery rate.