What criteria should I use to determine whether to refer a patient with a breech presentation to a specialist obstetrician?

Refer a patient with a breech presentation to a specialist obstetrician if the breech presentation is confirmed after 36+0 weeks of a singleton pregnancy to discuss management options including external cephalic version, vaginal breech birth, and elective caesarean birth. Referral is particularly important to offer external cephalic version if the woman prefers a cephalic vaginal birth. Additionally, if there are any complications or concerns such as suspected fetal growth restriction, abnormal fetal movements, or other obstetric complications, specialist assessment is warranted. Use abdominal palpation after 36+0 weeks to identify breech presentation and confirm with ultrasound before referral. The referral should also consider the woman’s preferences and any medical or obstetric complications that may affect mode of birth decisions. Clear communication and shared decision making with the woman and her partner are essential throughout the referral and management process.