A medical examiner testified that she believed a 23-year-old pregnant woman was conscious and trying to defend herself as a kitchen knife was used to crudely cut the baby from her womb as she was killed.

The testimony came Friday in the federal trial of 39-year-old Lisa Montgomery, who is accused of killing Bobbie Jo Stinnett and taking the baby on Dec. 16, 2004. Montgomery was arrested the next day while showing off her new child in Melvern, Kansas. She has pleaded guilty by reason of insanity.

"The evidence to me shows that she regained consciousness while the incision was being made, a struggle ensued and she was strangled again," said Dr. Mary Case, the St. Louis County medical examiner.

Case testified that she believed Stinnett was coming in and out of consciousness when Montgomery was cutting into her womb. Case, who did not perform Stinnett's autopsy, said the large amount of blood on the bottom of Stinnett's feet showed she had her feet flat on the floor — either standing or sitting with her knees raised — when she was cut.

She said that would not be possible if Stinnett was unconscious.

Coroner Miguel Laboy, who performed the autopsy and showed several graphic autopsy photos, said Stinnett had eight jagged cuts across her abdomen and what he called defensive wounds on her hands, face and elbows. He did not address the question of whether she was conscious when the incisions were made.

Also Friday, five women who lived or worked in Melvern at the time said they were surprised and skeptical when Montgomery and her husband showed up with a new baby on Dec. 17, 2004.

They said Montgomery and her husband, Kevin, seemed ecstatic about the new baby girl and that Lisa showed no signs of trauma or of being upset, and had answers for all their questions about the birth.

As the baby was being introduced in Melvern, investigators were closing in on Montgomery as a suspect in Stinnett's death after using Stinnett's computer to connect the two women through chat rooms and Web sites devoted to breeding rat terrier dogs.

All but one of the five Melvern women who testified said they were skeptical when they heard that Montgomery was pregnant in 2004, partly because Montgomery had claimed to be pregnant twice before and did not have a baby. They said she did not look pregnant, even a week before she introduced her new baby.

One witness, Jennifer Sage, said she had heard on the morning of Dec. 17, 2004, that a woman had been killed in Skidmore, Missouri, and a baby stolen. When Montgomery came to the Osage County Courthouse and said she had given birth at a birthing center in Topeka, Kansas, Sage called the center.

"It was very odd," she said. "It was just too weird for me."

Sage was not allowed to testify about what the center told her, but she said she told some co-workers of her concerns and one of them went to the Osage County Sheriff's Department.

Lisa Green, who said she believed Montgomery when she said she was pregnant, testified that she was not surprised when Montgomery called her the night of Dec. 16, 2004, and said she had given birth and was home with the baby.

Green, who worked with Montgomery at a Casey's convenience store, said Montgomery seemed in touch with reality and happy to be home.

Green also testified about problems Montgomery had with her mother and siblings, who she said were nearly always fighting. She also testified that Montgomery told her she had been raped by her stepfather as a teenager and her mother blamed her for trying to take her husband away from her.