All pregnant women spend nine months hoping and praying that their children will be born healthy and normal. Ten fingers and ten toes is the standard baby wish, and anything beyond that is a blessing. I was born with all my digits, but imagine my parents’ surprise when they turned me over to find my lower back covered with an angry red splotch. I was one of the one in ten children born every year with a vascular birthmark. There are many different types of birthmarks, which can appear on almost every part of the body. I sometimes felt self-conscious about my own, but growing up, very few of my friends didn’t have some sort of birthmark, whether it was a brown smear on an arm, a red port wine stain on the face, or in one friend’s case, a single purple toe. Birthmarks are extremely common, and luckily, they’re usually harmless. It’s not clear why some people get them and some don’t, but they occur most often in Caucasian children and up to five times more often in girls. They are sometimes apparent at birth, but some types of birthmarks develop soon after. There are many old wives’ tales about birthmarks; they are the sign of a mother’s unfulfilled wishes, the result of something the mother ate during pregnancy, or the product of a traumatic birth. The truth is much less sensational … they are not mom’s fault and they’re not contagious. Some birthmarks can have a genetic component, but most simply occur at random. Although having a birthmark in the Middle Ages might have gotten you accused of witchcraft, most marks today don’t have any serious or lasting effects on a person’s health. Birthmarks fall into one of two categories: pigmented or vascular. Pigmented birthmarks are a result of an overgrowth of melanocytes, the cells that regulate the pigment in our skin. Pigmented birthmarks are very common, including marks such as café-au-lait spots, moles, and Mongolian blue spots. Café au lait spots are coffee-colored spots that can appear anywhere on the body, although the smooth, rounded marks are usually found on the torso or lower body. Some children have multiple spots, and although they don’t fade, they are usually harmless. However, if you detect several of these spots, it could potentially be a symptom of a nerve disease and you should have them checked out by a doctor. Mongolian blue spots are curious, flat, bruise-like spots that often appear on a baby’s buttocks or lower body. This type of birthmark occurs most often in darker-skinned babies and is named for Attila the Hun, whose children were all said to carry the mark. Mongolian blue spots range in color from blue to black to grey, and almost always fade within a few years. Moles are a very common form of pigmented birthmark. Many fair-skinned people have a multitude of moles, usually brown or black in color. People with many moles have a slightly higher chance of developing skin cancer and should take precautions when in the sun. Some congenital moles can be abnormally large, but plastic surgeons can remove them. Just removing the mole, though, doesn’t reduce the chance of skin cancer, and anyone with moles should stock up on sunscreen. Vascular birthmarks are malformations of blood vessels and capillaries near the skin. Sometimes the vessels are abnormally wide, and sometimes there are simply too many of them, but they deliver a larger volume of blood to the affected area, causing colored marks and skin distortions. Macular stains are also sometimes called salmon patches, angel kisses, or stork bites. They are flat-pink or red marks that comprise the bulk of vascular birthmarks. The harmless marks occur most often around the face, head, or the nape of the neck, and usually fade after childhood. Hemangiomas can occur as either a raised mark on top of the skin or they can grow inward. They are bright red and usually raised or bumpy. Most hemangiomas are small and fade after childhood, but some can be large and leave a scar. Although hemangiomas are not usually dangerous, marks that occur near the face or head can interfere with breathing or vision, and should be monitored by a doctor. Sometimes they’re called strawberry hemangiomas because of the bumps on their surface. Port wine stains are the most severe and distressing of birthmarks, since they are often dark red or purple, and often highly visible. Mikhail Gorbachev’s famous forehead birthmark is an example of a port wine stain, although most of these marks occur on the face. Although not life threatening, they can affect the shape of the face, since the abundance of blood flow to the area can sometimes cause the skin to become stretched or distorted. Many people with port wine stains choose to undergo laser therapy to shrink the stain, since with age, the mark can take on a pebbled texture or affect vision and speech. Although most birthmarks are harmless and painless, a large birthmark can cause anxiety and shame for kids, who might also be prone to teasing or uncomfortable questions from classmates. For birthmarks that cause self-esteem issues or anxiety, medical intervention is possible. Some choose to have the mark treated with laser therapy to shrink the birthmark or make it less noticeable, and some use cosmetics to cover the discoloration. Some marks such as large moles or ingrown hemangiomas can be excised with plastic surgery. Any birthmark, once removed, can come back, so often the easiest thing to do is to leave it alone. Any birthmark that begins hurting, itching, bleeding, or becomes infected should always be examined by a doctor right away. Although they can be confusing to kids, our birthmarks become part of our identity. I know that I got off comparatively easy by having a birthmark that’s hidden by clothes, but I can’t even imagine my back without what my mom has always referred to as my “strawberry.” I even credit my birthmark from saving me from silly fashion trends—because of its location, I was never tempted to get a lower-back tattoo. I’ll take a splotchy, red birthmark over that any day.