Background: To demonstrate the changing trends in the delivery of breech presentations throughout the last four decades. Materials and methods: We retrospectively evaluated the birth data in the last four consecutive decades (1980s, 1990s, 2000s, and 2010s) for breech deliveries. A total of 25,513 deliveries between January 1980 and December 2017 were evaluated, with 371, 269, 292, and 275 breech deliveries in the 1980s, 1990s, 2000s, and 2010s groups, respectively. Results: The incidences of breech presentation for the 1980s, 1990s, 2000s, and 2010s groups were 4.3%, 4.8%, 5.6%, and 4.6%, respectively, and the mean gestational weeks at birth were 37.84 ± 3.23, 36.90 ± 3.22, 36.15 ± 3.22, and 36.35 ± 2.77, respectively. The average gestational week at birth had statistically significantly decreased over the decades (p < 0.001). However, the appearance, pulse, grimace, activity, respiration (APGAR) scores gradually increased (p < 0.001). The cesarean section (CS) rates were 67.6% (251/371), 90.3% (243/269), 96.6% (282/292), and 99.3% (273/275) for the 1980s, 1990s, 2000s, and 2010s groups, respectively, which were statistically significantly different (p < 0.001). The CS rate had gradually increased over the decades. Conclusion: Cesarean section rates in fetuses with breech presentation have gradually increased over the decades. Choosing vaginal delivery for selected breech presentations, providing proper education to obstetricians regarding breech delivery, regulating medicolegal issues, and encouraging physicians to perform more vaginal deliveries for breech presentation should be the key points in decreasing CS rates associated with breech presentation.