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nervous system response with a decrease in heart rate and blood pressure, and an increase in internal autonomic body functions, often referred to as the system that allows us to rest and digest. 28 Effects of Heat and Massage on the Autonomic Nervous System In 2011, researchers looked at the effects of heat and massage on the autonomic nervous system. Major factors being tested were heart rate variability, cortisol and norepinephrine hormones, and sympathetic skin response. At the end of the two-week study period, a significant reduction in the clients' serum cortisol levels was observed. At four weeks, a significant decrease in norepinephrine levels—neurotransmitters of the sympathetic nervous system responsible for increased heart rate, glucose levels, and blood flow to the skeletal system—was found, suggesting an overall reduction of sympathetic activity and a reduction in overall stress. 29 Effects of Swedish Massage on Hypertension In 2013, a single-blind US clinical trial examined the effects of Swedish massage on the reduction of hypertension in 50 female participants who were diagnosed with pre-hypertension. The study focused on creating a relaxing environment for all participants for the same frequency and duration—three times a week for 10 weeks. Of the 50 recipients, 25 received an extra 10–15 minutes of relaxing Swedish massage. Results indicated that the participants who received the additional massage component experienced positive effects of lowered blood pressure for up to 72 hours post massage. 30 Swedish Massage Versus Resting A separate study, in Malaysia, examined the correlation of a full-body Swedish massage versus resting one hour per week and its effects on stress and hypertension. Although both Swedish massage and rest resulted in significant reductions in blood pressure, anxiety, and heart rates, results showed that the effects of Swedish massage lasted up to four weeks and reduced the heart rate of hypertensive participants. 31 Effects of Massage on Biochemistry The International Journal of Neuroscience published a review of research studies that focused on the effects of massage therapy in relation to biochemistry, with an emphasis on its effects on decreased levels of cortisol and increased levels of serotonin and dopamine, in relation to medical conditions and stressful experiences. The measurable component of the studies reviewed were urine and saliva samples, with data from combined samples showing an average decrease of 31 percent in cortisol levels; when studies evaluated parasympathetic neurotransmitters in urine, there was an increase in both serotonin (28 percent) and dopamine (31 percent). 32 Studies seem to indicate that massage may reduce sympathetic hormones (like cortisol) while simultaneously increasing parasympathetic hormones (such as serotonin and dopamine), which contribute to the reduction of stress, pain, trauma, and disease. DISCUSSION African-American women are at the highest risk for maternal mortality in the US, and their babies are the most susceptible to infant mortality. A key risk factor for maternal and infant mortality among this population is hypertension, and it is my belief that significant contributors to this condition are related to chronic racial stress. Stress is increasingly seen as one of the major risk factors for the leading diseases we face today, including anxiety, cancer, depression, diabetes, gastrointestinal issues, headaches, heart disease, and now eclampsia, preeclampsia, and preterm labor. Although additional research is needed, an accumulation of studies suggests that massage can play a role in the fight against disease by supporting the healing effects on the autonomic systems in the body. Through massage, we may be able to reduce the fight-or-flight sympathetic hormones (such as cortisol), and possibly increase the parasympathetic hormones that allow us to feel happy, calm, and relaxed (such as dopamine and serotonin). As a result, pregnant African-American women and their babies may benefit from prenatal massage to increase their chances of a healthy, full-term delivery. It's a line of inquiry I challenge us in the field of manual therapies to pursue. Notes 1. Centers for Disease Control and Prevention, "Meeting the Challenges of Measuring and Preventing Maternal Mortality in the United States," November 14, 2017, accessed October 2020, www.cdc.gov/grand-rounds/ pp/2017/20171114-maternal-mortality.html; CDC, "Infant Mortality," reviewed October 2020, accessed 78 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 2 0 Through massage, we may be able to reduce the fight-or-flight sympathetic hormones (such as cortisol), and possibly increase the parasympathetic hormones that allow us to feel happy, calm, and relaxed (such as dopamine and serotonin).