Meconium aspiration syndrome (MAS) is a life threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Its obstetric and perinatal management has been changing for over 35 years. In pregnancies complicated by MSAF, suction of the hypopharynx before the delivery of the infant's shoulders and postnatal suction of vigorous infants have been used in an effort to clear the airway and decrease the incidence and the severity of the disease. Based on the results of two large RCTs, international guidelines from scientific societies for intrapartum and postpartum management of pregnancies with MSAF have radically changed. Intrapartum suction and postnatal intubation and suction of vigorous infants are not longer recommended. For depressed infants there are no randomized trials to support or to refute this practice. Other non recommended manoeuvres such as thorax compression and gastric lavage are still sometimes performed. The adherence to norms and recommendations is not uniform. Neonatologists should make efforts to get the new evidence more quickly move to evidence-based clinical practice.