Abstract Nearly a quarter of piglets are lost from farrowing to weaning, with stillbirths representing about 7.5% and preweaning mortality contributing another 15.7% in North America (Pigchamp, Metafarm). This averages to a loss of 7.37 pigs per sow per year resulting in significant economic loss and animal welfare concerns. Main contributors of low piglet survivability include poor sow body condition at farrowing, long farrowing duration, piglet asphyxiation, insufficient colostrum consumption, and health challenges. Piglet livability can be improved through nutrition and management solutions before, during, and after parturition. In this context three main strategies have been shown to be effective: 1) managing sow body composition, 2) improving fetal oxygen and nutrient supply via the nitric oxide pathway, and 3) improving piglet health through functional ingredients in the diet of the sow. Highly prolific sows (> 16 born alive) lose both backfat and muscle during the later stages of gestation. Additionally, loin depth loss is more detrimental for piglet survival compared with backfat loss. Sows with the highest stillborn (> 2 per litter) lose the most loin muscle depth regardless of genetics. A solution to reduce this effect and improve piglet survivability is a two-phase gestation feeding with more amino acids in late gestation. Average farrowing duration of a highly prolific sow is 300 minutes and increasing with larger litters. To make things worse, most sows are going through farrowing without food and/or drink. Nutrients and energy supply to sow are critical for shorting farrowing duration and piglet survivability. Compared with pigs that died before weaning, surviving pigs at weaning have greater blood oxygen and less carbon dioxide and lactate at birth. Nitric oxide boosting technologies have been used widely to enhance athletic performance and increase endurance. This vasodilative effect of nitric oxide can be used similarly in sows to increased placental blood flow and thus oxygen and nutrient supply to fetuses. This reduces the risk of asphyxiation and therefore can increase piglet vitality at birth and decreases stillbirth and pre-weaning mortality. Post-parturition health challenge poses a large risk to piglet survivability. Functional feed ingredients, such as botanicals, are a potential solution to improve piglet health and resilience to challenging conditions. Some botanicals can pass through placenta and milk to supply piglets. Milk from sows fed specific botanicals has been shown to improve inhibitory activity against Bacillus subtilis and Staphylococcus aureus. Some specific botanicals can improve sow and piglet antioxidant status, and piglet gut health. In conclusion, managing sow body condition, nitric oxide pathway stimulation, and functional sow diets are effective ways to improve piglet survivability in challenging environments.