Objective: To provide more evidence about the safety and effectiveness of external cephalic version (ECV) in a new hospital setting, and thus increasing its external validity of former studies, and estimate the costs avoided by implementing a protocol in order to attempt vaginal delivery of fetuses in breech presentation intended reduce the rate of caesarean section. Study Design: Prospective monitoring from December 2013 to December 2018. Setting: Department of Obstetrics and Gynaecology, Son Llàtzer University Hospital, Palma de Mallorca, Spain. Population: 561 female candidates who at 34–35 weeks’ gestation (WG) had fetuses in the breech presentation. Methods: Recruitment and training of personnel in ECV, information provided to midwives at the hospital and health centres in the area about the new care management algorithm, recruitment of the target population, appointment for consultation and application of the ECV protocol at 36-37 WG to confirm the persistence of breech presentation and perform ECV in the absence of contraindications. Results: Of 561 candidates, 403 women (71.8%) still had fetuses in the breech presentation. ECV was performed on 388, and the procedure was successful in 199 (55.9%). Of these, 153 (76.9%) had a vaginal delivery, in contrast with 4 (2.5%) for whom the ECV was not successful. The percentage of caesarean sections for breech presentation fell from 21.2% in 2013 to 12.2% in 2018 (a 42.5% mean reduction in incidence. The overall avoided expenditure from the start of ECV protocol application was €278,352.11. Discussion: The introduction of the ECV protocol reduced the number of breech presentations at term, prevented 153 caesarean sections for breech presentation, did not affect maternal or perinatal morbidity or mortality and can be considered an efficient intervention.