We welcome the interest expressed by Sheridan et al in our article examining the changes in vaginal breech delivery rates over a 16-year period. They are correct in their observation that our examination of the perinatal mortality rate (PNMR) relates to the whole population and not that of the breech population. As mentioned in the manuscript, the study is a retrospective observation, for which we used hospital annual clinical reports as our main source of data. Because of the nature of our data collection, specific examination of the PNMR of breeches was impossible. It is thus, difficult to speculate as to whether changes in management of breech deliveries has had an impact on PNMR of this patient group or on the institutional rates of PNMR of the 3 hospitals involved in the study. The term breech trial did, however, suggest an improvement in PNMR associated with delivery by elective caesarean section.

Standard management of breech presentations at all 3 institutions includes discussion about external cephalic version (ECV) at 37-38 weeks’ gestation. ECV is a valuable tool in efforts to decrease incidence of breech presentation. Rates of ECV participation and success rates during the study period were not, however, examined, as the aim of the study was to primarily examine changing practice relating to delivery of breech presentation. Future studies could investigate the implementation of ECV across the Dublin maternity hospitals.