RALEIGH, N.C. -- Republican lawmakers pushed ahead Thursday with their demand for new rules at North Carolina's abortion clinics, saying they will make the procedure safer for women. Opponents argued it was a blatant attempt to shut down clinics and curb a woman's right to choose.

The House voted 74-41 to approve new rules after a highly-charged, three-hour debate watched from the gallery by advocates on both sides of the issue.

The bill directs state regulators to change standards for abortion clinics to bring them in line with more regulated outpatient surgical centers. It also requires doctors to be present for an entire surgical abortion and when a patient takes the first dose for a chemically induced abortion.

The bill was tweaked after Republican Gov. Pat McCrory threatened to veto a separate bill approved quickly by the Senate last week. The governor said he supported more safety measures but was worried it would result in restricting a woman's access to an abortion.

House leaders adjusted the Senate's language with input from McCrory's top health agency administrator. The standards have not been changed since 1994, officials have said. The governor hasn't spoken publicly about the updated measure, which now must return to the GOP-led Senate next week. It would have to get approved there before it goes to McCrory's desk.

Democrats criticized the measure, saying it was considered with little debate and no proof from medical experts that different standards are needed.

The bill authorizes the state health department to apply standards for ambulatory surgical centers to the clinics to address on-site recovery, protect patient privacy and ensure patients with complications receive necessary medical attention "while not unduly restricting access."

Only one abortion operator in North Carolina is a licensed ambulatory surgical center. Many of the other 16 clinics in the state won't be able to comply with the regulations because it will be too costly to upgrade their facilities, women's health groups said.

Some clinics in South Carolina and Virginia have closed when faced with similar requirements, women's health groups say.

"It's a very bold in-your-face vicious attack on women's health," said Rep. Alma Adams, D-Guilford.

"This bill is not about safety. It is about limiting choice," said Rep. Jean Farmer-Butterfield, D-Wilson.

Republican women speaking for the measure said orders by state health officials to close clinics in Durham and Charlotte show the need for different standards. They said other clinics in recent years have had dirty, unsterilized equipment, dried blood on medical lamps and improperly used medicine.

"We've looked at the documented complaints," said Rep. Sarah Stevens, R-Surry. "Don't tell me this isn't about health and safety. That is exactly what it's about."

The measure also would prohibit carrying out abortions on the basis of gender, curb abortion insurance coverage and expand the ability of doctors and nurses to refuse to participate in an abortion on ethical or religious grounds to other medical professionals.

Abortion rights advocates were incensed about how the measures have come through the legislative process over the past week.

The Senate bill was inserted into an unrelated House measure to prohibit North Carolina judges from applying part of Islamic Sharia law or other foreign law in certain cases. The House bill considered Thursday was inserted Wednesday into a bill designed to increase penalties against motorists who cause serious motorcycle accidents. There was little or no advanced notice for the changes.

Some women opposed to the bills wore motorcycle helmets in the gallery at the time of the vote. Five women wore white shirts, each with a letter to spell "SHAME." They stood during the debate.

"If they're so concerned about women's health and safety, why are they afraid of public scrutiny?" said Paige Johnson with Planned Parenthood of Central North Carolina.

Johnson said she and other abortion rights activists would continue to apply pressure on McCrory to veto the House measure, which she predicts he'll do. McCrory said last October he didn't want to sign into law any additional abortion restrictions.

Rep. Ruth Samuelson, R-Mecklenburg, one of the House bill's primary sponsors, told colleagues that state Health and Human Services Secretary Dr. Aldona Wos supported the new bill's language. She said House leaders gave time for representatives to consider the Senate bill and debate the House substitute.

Barbara Holt with North Carolina Right to Life said her group is heartened to have a Republican-led legislature in North Carolina support additional restrictions on abortion for the second consecutive two-year session. Under Democratic control of the General Assembly before 2011, Holt said, no abortion-related bills her group supported could get passed.

"The people of this state and the people of this country have been waiting years to see commonsense provisions passed," Holt said.