NEW YORK -- Shortly after midnight on a recent Sunday, in one of the poorest neighborhoods of New York City, 20-year-old Yesenia Rice gave birth in a clinic several miles from the nearest hospital.
Her mother-in-law and aunt sat behind her on the thick double bed, one advising her to "yell and scream" and the other urging her to "breathe, breathe, breathe." Her mother stood behind the bathroom door, glad to be near her daughter but unable to watch the unmedicated pain.
When the baby was finally born, after 33 hours of labor, the midwife cradled him briefly while his father, Kyle Rice, cut the umbilical cord. Then the midwife placed the glistening infant on his mother's belly.
Less than eight hours later, far sooner than a hospital would have allowed, Ms. Rice was home with her husband and son in their apartment in the Morris Heights section of the Bronx.
The birth of Stefen Marc Rice at the Childbearing Center of Morris Heights last month is part of the search for cheaper and better health care for poor urban women.
The solution, many health care experts say, may be centers where prenatal care, labor, delivery and follow-up care are all given outside the hospital.
The centers serve women with no health problems and no reason to believe they will have a complicated pregnancy. Hospitals are used as backup if complications occur.
The experiment is based on two encouraging facts, one economic, one medical. Births outside a hospital cost about $3,300 in the New York area, 60 percent less than traditional hospital care.
In addition, at least one study, reported in the New England Journal of Medicine four years ago, found that birthing centers have half the newborn mortality rate of hospitals.
Still unanswered, however, is a question of culture: Can these centers be made attractive to women who have come to shun what they see as old-fashioned ways and who believe that expensive modern technology is better?
"They're in the United States now," said Jennifer Dohrn, director of the center in Morris Heights, an area where many families come from countries where midwives and home births were the norm. "They want access to the hospitals and the machines. It's an extra challenge to explain what we're all about. When it works, it's spectacular."
Although there are a handful of similar centers serving migrant women in rural Texas, the 4-year-old Morris Heights center was the first in the country intended for a poor, urban neighborhood. The center was established by the Maternity Center Association, which also runs a center on the Upper East Side.
Its success, in turn, has led to the creation of a center in the East New York area of Brooklyn, near Kings County Hospital, scheduled to open this fall. If that works, Health and Hospitals Corp., which will run the East New York clinic and which runs the city's 11 municipal hospitals, has expressed interest in opening other centers citywide.
The history of the centers began less than 20 years ago in response to the demands of middle-class women, who viewed childbirth as a natural experience, not an illness, and who wanted more control over how and where they gave birth.
Many obstetricians were, and still are, critical of the decision to give birth outside a hospital, citing the small, but real, risk of complications needing immediate, high-tech care.
But most states now license birthing centers, and 135 such centers have opened in the United States since 1975. Until the Morris Heights center opened, most were in middle- and upper middle-class areas.
At these centers, birth occurs in home-style bedrooms, without medication, monitors or doctors. Women can use a Jacuzzi to help them relax or the kitchen if they feel hungry. Family and friends gather around to coach and watch. Often children are invited. After the birth, new mothers rest for no more than 12 hours and then go home.
"At the hospital they would have attached me to a monitor and not let me move around," said Ms. Rice, who spent much of her labor circling a large flower pot in the center's waiting area.
"There would have been drugs, and they would have taken the baby away to the nursery," she said, as her son slept by her side. "This way is more natural."
So far, 410 babies have been born at the Morris Heights center. The Bronx Lebanon Hospital provides backup services, and the center accepts both Medicaid and private insurance.