They were poor, did not speak English, and had been in America just four months, but Yashoda Gurung said she still wanted her mother to have the baby.

Karnamaya Mongar was insistent, though. After 20 years living in tin-roofed huts in a Bhutanese refugee camp in Nepal, a fourth child would be too much.

"She said, 'We're just getting started here,' " Gurung testified Tuesday.

So, about 16 weeks pregnant, the 41-year-old Mongar embarked on an odyssey from her new home in Woodbridge, Va., to get an abortion.

The quest ended Nov. 19, 2009, at the Women's Medical Society clinic in West Philadelphia, where Mongar got her abortion, went into cardiac arrest and a coma, and died the next day.

Gurung, 26, told the Philadelphia jury hearing Dr. Kermit Gosnell's murder trial about her mother's death during an often-emotional two hours of testifying with the help of a Nepalese interpreter.

She wept when Assistant District Attorney Joanne Pescatore projected a photo of her mother and father, Ash Mongar, smiling new immigrants posing in the National Air and Space Museum.

Though abortion is legal in Pennsylvania and many other states up to 24 weeks of pregnancy, the end of the second trimester, Mongar's story shows how difficult it can be to get one.

The family clinic near Mongar's home - about 20 miles south of Washington - said it did not perform abortions after 14 weeks.

Gurung said that the clinic directed her mother to another clinic in Fredericksburg, Va., but that one also turned her down and suggested an abortion clinic in Washington.

The D.C. clinic also said no, Gurung said, but told them that Kermit Gosnell in Philadelphia would likely be able to help them.

Gurung testified that an appointment was made and that on Nov. 19, 2009, her uncle Damber Ghalley drove her mother, Gurung, and her mother-in-law on the five-hour trip to the redbrick clinic at 3801 Lancaster Ave.

Mongar died the next day in the Hospital of the University of Pennsylvania. Prosecutors allege she was killed when Gosnell's untrained staff gave her too much Demerol to anesthetize her.

Gosnell, 72, is charged with one count of third-degree murder in Mongar's death.

Gosnell is also on trial on seven counts of first-degree murder: seven infants allegedly born alive during abortions and killed by his cutting their spinal cords. If the jury finds him guilty, Gosnell could be sentenced to death.

Gosnell attorney Jack McMahon has argued that none of the infants was killed; rather, he has said, they were in death throes from the abortion drug, Digoxin, that Gosnell administered earlier.

Ghalley, who has lived in the United States since 1999 and speaks English, described the chaos at the clinic as firefighters and paramedics arrived to transport his unconscious sister to the emergency room. He said firefighters had to use bolt cutters to open the emergency exit leading to a ramp to the sidewalk.

Ghalley testified that he saw Gosnell standing in the open door to the clinic and asked what happened.

"He said, 'The procedure was done but your sister's heart stopped,' " Ghalley testified.

The next day, Ghalley continued, he accosted Gosnell in the hospital parking lot, and Gosnell repeated his earlier answer, adding, "I didn't do anything wrong. I'll be able to answer any question anywhere."

Among the other witnesses who testified Tuesday was James Johnson, Gosnell's janitor and handyman at the clinic and the doctor's other properties.

Johnson, who is married to a foster sister of Gosnell's wife, Pearl, testified that the clinic had frequent plumbing problems.

Toilets blocked up weekly, Johnson testified, but he refused to clean out the waste pipe.

"I told the doc I would remove the toilet and lay it on its side, but somebody else would have to clean that out," Johnson said.

Johnson's graphic testimony drew tears from some in the audience, including Day Gardner, president of the Washington-based National Black ProLife Coalition.

The jury also heard two visitors to the clinic describe its "filthy state" in 2008 and 2009.

One, Della Mann, who worked as a registered nurse in Gosnell's practice for about four years in the early 1980s, said she returned to work for Gosnell in December 2009 but quit after two days.

"It was awful," Mann testified, adding, "I didn't want to risk my license."