The consultant obstetrician who treated Savita Halappanavar refused her request for a termination because of "the legal position in Ireland", she has told the inquest into Ms Halappanavar's death.
However, a day later, when she formed the view that there was a "real and substantial risk" to Ms Halappanavar's life, Dr Katherine Astbury resolved to go ahead with a termination even though a foetal heartbeat was still present.
However, this did not prove necessary as a scan showed the foetus had died, four days after Ms Halappanavar was admitted to Galway University Hospital.
Dr Astbury's statement, which she read at the end of yesterday's second day of evidence at the inquest, makes no reference to the claim by Ms Halappanavar's husband Praveen that she was refused a termination "because Ireland is a Catholic country". Lawyers for Dr Astbury have indicated she will deny this claim when she is cross-examined today.
A family friend of the Halappanavars, Mrudula Vasealli, told the inquest yesterday that an unidentified midwife responded to the request for a termination by saying “We don’t do that here, dear. It’s a Catholic thing.”
Initial plan
Dr Astbury said her initial plan after Ms Halappanavar's membranes ruptured was to "await events". She says she discussed the risk of sepsis and the need to avoid her sitting on the ward undelivered for a protracted period after the foetus died.
Her statement refers to one request by Ms Halappanavar for a termination, whereas Mr Halappanavar says the couple made three requests over two days after she learned the foetus, while alive, was not viable.
According to Dr Astbury, her patient inquired about the possibility of giving her medication to cause her to miscarry as the outlook for the pregnancy was poor and she did not want to have to await events.
“I recall informing Ms Halappanavar that the legal position did not permit me to terminate the pregnancy in her case at that time,” she said.
The following day, after Ms Halappanavar’s temperature spiked and her pulse rate doubled from when she was admitted, she advised the couple of her concern that Ms Halappanavar had inflammation of the membranes due to infection. If she did not “continue to improve we might have no option but to consider termination regardless of the foetal heart”.
Second opinion
She obtained a second opinion from an obstetrician colleague, and they discussed the issues, including whether to write a note on the medical chart saying a termination appeared to be required at that stage "on the basis there was a real and substantial risk to the life of Ms Halappanavar".
Abortion is permitted in Ireland in circumstances where there is a “real and substantial risk” to the life of the mother.
Later that day, Ms Halappanavar delivered the dead foetus when doctors were inserting a central line to administer fluids and drugs. Her condition continued to deteriorate and she died of septicaemia due to E.Coli on October 28th, 2012, a week after admission.
Dr Astbury offered her condolences to Mr Halappanavar and his family.
A number of other doctors and a midwife who treated Ms Halappanavar gave evidence yesterday. Two of those initially diagnosed back pain but agreed that in retrospect she was suffering uterine contractions or miscarriage.
Midwife Miriam Dunleavy told the inquest her notes were added to afterwards by the hospital's internal investigation. Lawyers for the hospital, responding to queries from coroner Ciaran McLoughlin, said they would check the exact situation.
