Meconium-staining of amniotic fluid (MSAF) is a physiological finding in many pregnancies, particularly postdates; however, its presence can have detrimental effects on the fetus. Chorioamnionitis is often associated with MSAF. If signs of infection are present with meconium-stained amniotic fluid, hypoxic stress should be reduced or even avoided to reduce the risk of hypoxic-induced encephalopathy. Meconium Aspiration Syndrome is a known complication that can potentially be very severe and lead to respiratory failure in the newborn. The risk of this can be reduced if labour is managed appropriately by avoiding extensive periods of hypoxic stress, such as prolonged periods of pushing or injudicious use of oxytocin infusion. The thickness of meconium should not be classified into significant or non-significant, as possible damage to a fetus can occur with the same amount of meconium regardless of the dilution in different amounts of amniotic fluid. Continuous electronic fetal heart monitoring should be recommended in the presence of meconium, and should be interpreted based on the application of fetal pathophysiology and wider clinical context, including progress of labour.