INTRODUCTION:: We have established a Vaginal Breech Initiative (VBI) to increase access to, and training in, the process of vaginal breech delivery. The VBI is a collaborative care team composed of physicians and nurse-midwives that leads care of participating women. Components of the VBI are: thorough antenatal screening, strict inclusion and exclusion criteria, rigorous informed consent, established delivery guidelines, and frequent simulation training. METHODS:: This is a retrospective analysis of the VBI from 8/2011 to 11/2017. Inclusion criteria were: gestational age 34-42 weeks, singleton pregnancy, estimated fetal weight 2000-3800g, frank or complete breech, flexed head, adequate clinical pelvimetry, head and abdominal circumference within normal range and concordant, spontaneous labor and presence of a Vaginal Breech Team member. The primary outcome was incidence of vaginal breech delivery. Maternal and neonatal outcomes were examined secondarily. RESULTS:: In total, 47 patients underwent a vaginal breech trial of labor, of which 72.3% had a successful vaginal breech delivery (n=34/47). Piper forceps were utilized in 11.8% of deliveries (n=4/34). The incidence of postpartum hemorrhage was 2.1% (n=1/47). There was one 3rd degree laceration (2.1%; n=1/47). Neonatal outcomes included an 8.5% incidence of neonatal intensive care unit admission (n=4/47) and a 2.1% frequency of head entrapment (n=1/47). CONCLUSION:: The majority of patients undergoing breech vaginal delivery through our VBI had a successful vaginal breech delivery. Perinatal morbidity outcomes were rare. Through careful patient selection, counseling, and collaboration, breech vaginal deliveries performed in the context of a VBI are feasible in an academic medical center.