Two of the maternity hospitals with the highest number of births in Portugal are private institutions, a shift that analysts link to the country’s rising caesarean rate, now at a record high. The expansion of deliveries in the private sector appears to be a key driver of growing caesarean use nationally, while within the SNS the public unit with the most births is Maternidade Alfredo da Costa. The pattern raises questions about clinical practice variation between sectors, implications for maternal and neonatal outcomes, and the need for policy and oversight to address incentives and standardise care.