The small baby is a major challenge of modern obstetrics. Not only is low birth weight the most important factor associated with perinatal mortality but there are also dangers of short and long term mental or physical handicap in survivors. General management includes treatment of maternal disease, cessation of substance abuse, good nutrition and institution of bed rest. Although not of proven benefit, bed rest may maximize uterine blood flow. In any case, antenatal testing should be instituted. Because the task of the obstetrician is to deliver the baby in the best possible condition, which is possible only if the baby at risk has been recognized during the antenatal period, the place of intrapartum monitoring and the use of cesarean section in the management of the small baby are questions of everyday relevance to the practicing obstetrician. Delivery should be in a hospital capable of dealing with the various neonatal morbidities associated with growth restriction, including asphyxia, sepsis and malformations. Minimizing hypoxic episodes during labor and delivery, as well as optimizing neonatal care for these infants, will likely produce the healthiest outcome.