External cephalic version (ECV) is well established as an option for women with breech presentation at term (1). Safety of ECV is particularly important when the main alternate management of breech presentation at term is elective cesarean section (CS)(2). In an era of safe elective surgery and anesthesia, small family size and low patient and clinician tolerance of fetal risk (3), the possibility that a "successful" ECV could replace a relatively safe elective CS with a more hazardous emergency CS is of concern .The 2006 Royal College of Obstetricians and Gynaecologists' Green Top Guideline (1) quoted a doubling of emergency CS, but relied on studies published before 2003. This article is protected by copyright. All rights reserved.