Health bosses have voted to permanently downgrade maternity services at a hospital in Oxfordshire.
Because of problems recruiting doctors, Banbury's Horton General Hospital became a midwife-led unit last year.
The change prompted protests by campaigners and met "almost universal" opposition in a public consultation.
But Oxfordshire Clinical Commissioning Group (OCCG) argues midwife-led units are an "excellent option" for women with low-risk pregnancies.
At a board meeting earlier its members said a "staffing crisis" had caused the change, particularly a lack of obstetricians.
Protesters chanted "hands off our NHS, stop the Tory cuts" and "refuse the cuts or resign" as board members arrived.
Louise Wallace, lay board member for public and patient involvement, said there were "very, very, strong" public views, adding that all of the 1,200 public comments were against the change.
Banbury MP Victoria Prentis said pregnant women in the town will now spend one-and-a-half hours in a car while in labour to reach the John Radcliffe Hospital in Oxford, and it was "utterly unreasonable."
Keith Strangwood from campaign group Keep the Horton General argued the decision was all about money, and added: "The government bailed out the banks, why can't it bail out the NHS?"
Dr Joe McManners, clinical chair of OCCG, said there was a "workforce crisis" for recruiting obstetricians, and no "viable long term option" had come forward to run a doctor-led maternity unit in Banbury.
The meeting was also told the changes had been endorsed by consultant obstetricians at the John Radcliffe Hospital.
On Tuesday, the county's Health Overview and Scrutiny Committee decided to refer the decision to Secretary of State for Health Jeremy Hunt, who now has the option of calling for an independent review.
Witney MP Robert Courts supported the referral and said the downgrade had been decided "too quickly", and should have been delayed.
Other changes agreed as part of a plan to transform the county's health services include downgrading the Horton's critical care unit and removing 146 beds across the trust.
A total of 110 beds have already been closed, and a further 36 will be removed if progress is made tackling the problem of patients being stranded in hospital when they no longer need to be there.
Oxfordshire's health bosses have said they also needed to plug a £200m shortfall by 2020-21.