Background: A breech birth is the birth of a baby from a breech presentation. In breech presentation, the baby enters the birth canal with the buttocks or feet first, as opposed to the normal head first cephalic presentation. About 3–4 % of all pregnancies have breech presentation at term. First-time breech presentation at term occurred in 4.2% of first pregnancy deliveries, 2.2% of second pregnancies and 1.9% of third pregnancies. The rate of breech recurrence in a second consecutive pregnancy was 9.9%, and in a third consecutive pregnancy after two prior breech deliveries was 27.5%.Delivery of breech presentation was associated with increased risk for both mother and fetus as compared to cephalic presentation. Despite of this evidence there was scant information in breech presentation and its associated adverse maternal and perinatal outcomes. Understanding the burden of breech presentation and associated factors is important to help designing strategy to reduce those adverse perinatal and maternal outcomes related to breech presentation. This study aims to determine the mode of delivered associated perinatal and maternal outcomes for breech delivery at Kilimanjaro Christian Medical Center (KCMC). Objective: To evaluate mode of delivery and birth outcome of breech presentation in multiparous women and assess overall risk for cesarean mode of delivery at KCMC hospital Methodology: This was a retrospective cohort study was conducted using KCMC medical data. The study was conducted at KCMC Obstetrics and Gynecology department. KCMC is one of the four hospitals in Tanzania and was involves all multiporous women delivered at KCMC Referral Hospital at maternity ward between 2010 to 2015. We excluded nullporous and multiple gestation to minimize over representation of high risk women and missing data were excluded. Descriptive statistics were summarized using frequency and proportions; student t test was used to compare differences in mean between groups, Chi square test statistics was used to compare difference of proportions between categorical variables. Both crude and adjusted odds ratio (ORs) with 95% CI for risk factors and maternal and perinatal outcome associated with multiporous breech presentation was computed using multiple logistic regression models. P value of less than 5% (2 tails) was considered statistical significant and data were analysed by SPSS program. Results: Women with age less than 30 years were significantly associated with caesarean section as mode of delivery, age less than 30 years were 2 times higher odds of delivery through caesarean section compared to women with age more than 30 years OR 2.34 (1.21- 4.72), Married were 2 times higher odds of delivered through caesarean section compared to unmarried women OR 2.44 (0.45-0.9), Women with higher level of education were 2 times x higher odds of delivery through caesarean section compared to women with primary education. Women with cord prolapsed were 2 times higher odds of delivery through caesarean section compared to women with no cord prolapsed OR 2.1 (1.2-5.6), attended antenatal visits more than 4 were 2 times higher odds of delivery through caesarean section compared to women with less than 4 antenatal visits OR 2.14 (1.11-4.17).Pre-eclampsia women and women with gestation age less than 37 weeks were 2 times higher odds of delivery through caesarean compared to women with gestation age more than 37 weeks OR 1.5 (1.67-2.51). Children with Apgar score at 1 minute more than 7 were 6 times higher odds of being delivered through caesarean section compared to children with apgar score less than 7. Also children with apgar score more than 7 at 5 minute were 5 times higher odds of delivered through caesarean section compared with children less than 7 apgar score at 5 minute and children with birth weigh more than 2.5 Kg were 3 times higher odds of delivered through caesarean section compared to children less than 2.5 Kg. Neonatal death, congenital abnormality, intra-uterine fetal death outcomes were assessed but found not to be significantly associated with caesarean section delivered. Maternal death, premature rupture of membrane outcomes were significantly associated with mode of delivered, multiparous women women with no death during delivered were 2 times higher odds delivered through caesarean section compared to women with death during delivery. Admission to ICU, pre eclampsia, Ante partum hemorrhage, eclampsia, blood loss more than 500 ml and placenta abruption also were assessed but found not to be significant associated with mode of delivery (caesarean section). Conclusion: In study cesarian section is seem to be preferred mode of delivered in breech presentation since it reduce both maternal and fetal birth outcome. Furthermore vaginal breech delivery was associated with higher fetal death, low apgar score both at 1 and 5 minutes and low birth weight compared with caesarian section delivery. Early identification breech presentation and provision of appropriate management during labour and delivery may reduce the poor maternal and perinatal outcomes among women with breech presentation. Although vaginal breech delivery was shown to have more adverse fetal outcomes compared to caesarian section should not be discouraged as it have some benefit for the mother in terms of blood loss and wound infection.