Since historical times, the presence of meconium in the amniotic fluid has been worrisome for midwives and accoucheurs alike. Its association with a neonate who does not cry has often been a chill factor in delivery suites. Having said that, all cases of meconium-stained amniotic fluid (MSAF) do not necessarily result in low APGAR scores. In addition to in utero fetal hypoxia, meconium passage has also been associated with maternal drug abuse, use of vaginal misoprostol for induction of labor, chorioamnionitis, and maternal diabetes. The main pathology associated with MSAF is the aspiration of meconium during intrauterine gasping or during the first few breaths. This causes meconium aspiration syndrome (MAS) which has serious consequences on neonatal outcome. MAS is a common cause of severe respiratory distress in term neonates, with an associated highly variable morbidity and mortality. The pathophysiology of MAS is multifactorial and includes acute airway obstruction, surfactant dysfunction or inactivation, chemical pneumonitis, and persistent pulmonary hypertension of a newborn. Concepts regarding meconium and the management of MSAF to prevent MAS have changed in the last two decades or so. Guidelines published by the American Academy of Pediatrics/American Heart Association have changed the immediate neonatal management following delivery in the presence of MSAF. Initially, amnioinfusion was considered an important tool in the management of MSAF. However, evidence to support this view has not been forthcoming and current guidelines recommend amnioinfusion only in controlled and research settings. The future thrust should be aimed at early detection of MSAF and prevention of MAS. Needless to say, the obstetrician and the neonatologist need to work in consonance for achieving a better neonatal outcome in the presence of MSAF.