A GALWAY midwife has admitted telling Savita Halappanavar that she could not have a termination because of the Catholic ethos of the country.
Ann Maria Burke, a clinical midwife manager at the hospital, said that the comments made on Tuesday October 23 had since caused her great upset and she had never made them in a "hurtful context".
She also rejected ever having referred to Ms Halappanavar as "dear" when telling her the termination could not take place.
"I'm upset about this and I'm very upset. I did mention a Catholic country, I didn't mention it in a hurtful context," she told the inquest.
Ms Burke said she was speaking with Savita about what would occur in India and the Hindu faith had been mentioned in the conversation. Ms Burke was explaining why things were different in Ireland, she told the inquest.
"So it was not in a context to offend her, I'm sorry if if came across. I don't think I came across as insensitive at the time. It does sound very bad now, but at the time I didn't mean it," she said.
"It was more to give information and to kind of throw light on our culture than to be hurtful or insensitive," she added.
Ms Burke said she had thought of the conversation more as a chat and was nothing to do with medical care.
"She had mentioned the Hindu faith that this would happen and there would be no problem, and I really had to say something and I was trying to be as kind as I could. And it came out the wrong way and I'm sorry," she added.
Coroner Dr Ciaran McLoughlin pointed out that the comments had gone around the world. He stressed that no hospital in Ireland followed a religious persuasion or dogma which Ms Burke readily accepted.
The inquest, in its third day at Galway courthouse, has heard claims that a consultant obstetrician, Dr Katherine Astbury, made the remark to Mrs Halappanavar and her husband Praveen, and also that the midwife said it.
Dr Astbury, who was cross-examined over her treatment of Mrs Halappanavar for several hours today, denies using the phrase.
But the consultant has admitted there were system failures in her care and she also warned of a lack of legal clarity for doctors treating pregnant women who suffer health risks.
Mrs Halappanavar was 17 weeks pregnant when she was admitted to the hospital in pain.
Dr Astbury revealed there is confusion over how her patient was cared for, including that she had been unaware of blood test abnormalities and that the patient's vitals should have been checked more regularly after her foetal membrane ruptured.
The senior medic was asked by coroner Dr Ciaran MacLoughlin if the two aspects of Mrs Halappanavar's care could be seen as system failures.
"Yes," she replied.
Dr Astbury revealed that she initially refused a request from the Halappanavars to terminate the pregnancy two days after her admission to hospital as at that time there was no risk to her life.
"She was well," said Dr Astbury under cross-examination.
"There was no risk to her life.
"If you need to give somebody medication to deliver and there's a foetal heartbeat, my understanding is that legally you are considered to be terminating."
Dr Astbury spoke in a loud, clear voice as widower Praveen Halappanavar, who claims she made the Catholic remark, sat with his friend, a Galway-based consultant Dr CVR Prasad, who read through documents.
She addressed the Irish Medical Council guidelines on abortion which refer to terminating a pregnancy if there is a risk to the mother's life.
She said her understanding was that they relate to conditions such as cancer, such as women getting radiotherapy, cervical care or a hysterectomy.
"My understanding is that this is a case where a woman is diagnosed with a life-threatening illness, usually unrelated to the pregnancy," she said.
Dr MacLoughlin asked if there was confusion over the interpretation of the guidelines.
"There's no law to tell you what you what is permitted or not permitted," she replied.
Dr Astbury insisted that when she told Mrs Halappanavar she could not abort the baby on the Tuesday, she used the words: "In this country it is not legal to terminate a pregnancy on grounds of poor prognosis of the foetus."
The doctor agreed that in other jurisdictions Mrs Halappanavar would have been offered the option of a termination if the prognosis of her foetus was poor.
"The law in Ireland does not permit termination even if there's no prospect of viability," she said.