* Suturing actual, living tissue is much more difficult than practicing on, say, cow-tongue or a chicken breast. (Or, for that matter, a foam dummy) You've got a mom who can often feel at least some of what you're doing, there's labia and tissue to hold back, and blood seeps into the viewing field (dab... dab... dab...). On top of this, you're wearing sterile gloves which are almost always tacky with blood by this point. And - I'll be honest here, even though I know how 'forgiving' the perineal tissues are and how well they heal - you want it to look nice. (For anyone who hasn't seen the vaginal/labial/perineal tissues of a woman right after delivery - picture a gooshy, glistening mass of ... I don't even know what. I'm only now, finally, I think getting the hang of what goes where. On that note --- any volunteers so I can practice?!)
* There is a huge range of philosophies/practice among midwives - and that's okay. The things I learned with the Midwife and want to remember/use, I can. The ones that I didn't feel comfortable with at all, I can drop in favor of something that reaches the same goal but feels "right" to me. For example, the amount of traction needed to help the placenta separate and deliver, or the choice to leave a mom's perineum and labia alone as the baby crowns (while still reserving the right to support both, and maybe help stretch on occasion, if needed, rather than for every birth).
* You gotta use a heck of a lot of traction to help resolve a shoulder dystocia.... I always fear that I am going to injure the baby when using excessive traction, but when looked at it from a different, more sombering perspective --- a baby with a broken clavicle or even nerve injury, is better than a baby that never is.
* I got this.