Approximately 5% of term pregnancies present in breech. Reduced exposure to vaginal breech birth by clinicians has narrowed the choice and contributed to avoidable harm. Emerging evidence supports physiological vaginal breech birth and structured management using the Physiological Breech Birth Algorithm. The OptiBreech Collaborative Care model operationalises this evidence through specialist clinics, continuity of care, and trained teams. Evidence demonstrates improved informed choice, neonatal outcomes comparable or superior to standard care, and cost-effectiveness. Core safety principles include timely progress once the buttocks are visible, completion of birth within 7 minutes, sustained maternal effort, and intact–cord resuscitation when needed.