Hehir et al report a significant decrease in rates of vaginal breech delivery in both nulliparous and multiparous women over a 16-year study period in Dublin, Ireland. They also report a significant decrease in the perinatal mortality rate (PNMR), although this refers to the whole population rather than reporting and comparing the PNMRs of the 11,913 term breech babies with the rest of the population (Table 2). Thus it is impossible to conclude whether the changing management of breech presentation made any contribution at all to the falling overall PNMR.

It was heartening to read that all women with a breech presentation at 37-38 weeks’ gestation were counselled and offered external cephalic version (ECV). However, it would have been more informative if the number of successful ECVs were also reported in order to assess the commitment to this evidence-based standard of care that benefits both mother and infant. A 3.5% breech rate at term birth during the study suggests there may have been a low detection or uptake and success rate for ECV.