Maternity units in Aboyne and Fraserburgh are set to close after backing by local health chiefs.
The proposals for changing the provision of maternity services across the region include creating community maternity units in Aberdeen, Inverurie and Peterhead, while consultant units in Aberdeen and Elgin will remain.
The plans, supported by NHS Grampian, will now be submitted to the Scottish Government for final consideration.
An NHS Grampian spokesman said: “The proposals aim to provide a service that is safer and more sustainable and which will better meet the needs of all women and families across Grampian as well as women from Orkney, Shetland, Highland and Tayside who need specialist care at Aberdeen Maternity Hospital.
“The proposals also aim to ensure resources (staff, budget and buildings) are used more fairly, effectively and efficiently.”
The recommendations also include offering a home birth service across Grampian and a longer term aim to relocate Aberdeen Maternity Hospital on the Foresterhill site.
A consultation found that 43% of people who took part fully supported the proposals, while 47% gave partial support. The remaining 10% were totally opposed to the plans.