Maternity Benefits in Japan

I had two fairly long meetings today with my boss and the ladies from the finance department sorting out all the ins and outs of my upcoming maternity leave. I had no idea how much I didn't know.

Now, for the 7 or so dedicated readers out there (eg friends and family that haven't given up on me) this is going to be a long, dull post. The general summary I have explained before is basically still true.

This post however, is meant for any other expats here in Japan who just found out they're pregnant and want to know what to expect in terms of maternity leave. I'm going to get into a lot of the gritty details that really aren't that interesting unless you're planning your budget around them.

And here's what I found out...

First, its important to understand that maternity benefits are paid by insurance companies and the government - not the company / school you work for. I am also about to describe maternity leave for mothers working full time. I don't know what the system is if the mother is unemployed (thought I know there is some system in place for those mothers as well.)

6 weeks before the due date established by the hospital, mother's-to-be are eligible to begin their maternity leave. They can forfeit all or part of their leave if they have a doctor's note agreeing that they are healthy enough to continue working, but taking full leave seems to be pretty normal. Once leave starts, the employer no longer pays any sort of salary to the mother. Instead, insurance kicks in. The good news, is that insurance pays 80% (at least, mine does - I had originally heard 66%, so it may be variable depending on your insurance). The bad news is that you can't apply for that 6 weeks at 80% pay until the baby is born. After the birth, you fill out some paperwork and you get the 80% for however many days you were on leave (varying, of course, by when the baby decides to make his or her appearance). If your baby comes early - say after only 5 weeks of leave, you get 5 weeks at 80%, if he/she comes at 7 weeks, you get 7 weeks at 80%. Of course, that means a month and a half when you get no pay at all before you have a birth date to report. You get the money eventually, but you'd better hope you have a second income or some savings socked away to live on during your maternity leave.

So the baby arrives, you report the birth to the city (which involves taking the newborn in for visual confirmation) and you get a stamp in your mother/child book that confirms you do, indeed, have a baby. At this point you can apply for the pre-birth maternity leave, and your timer starts over for another 2 months at the same 80% rate. Since I had heard 66% pay, this was good news for me. However, the bad news is that, once again, you can't apply for the money until after the time has elapsed. So while you did just get paid for the 6 weeks prior to the birth, you have to live with no further pay for another two months. At which point you fill out more paperwork to apply for the post-birth 2 months of pay.

During this initial period of maternity leave, when you are still receiving the bulk of your pay, you are still accountable for your health insurance costs and your national pension costs. The way my university handled that, they figured out how much I would have to pay in insurance and pension for those months, and asked me to pay up front - before I start my leave. They will then pay this for me. I have a bit of sticker shock from the experience since I wasn't expecting it, but it does mean I'll have fatter checks when they do actually come through. Its a darn good thing I had some savings to raid.

As a side note, it was also pointed out that since the end of my post-birth 2 month stint comes right at the tail end of November, I am potentially very lucky. If the baby arrives before or on his due date, I only pay my pension and insurance through October. If, however, the baby takes his time and is a couple days late, causing the 2 month stint to end in December - even December 1st - we're going to have to pay one more month of pension and insurance. So here's hoping our kid has a better sense of timeliness than his dad or I do.

And that leads to the interesting stage after those post-birth 2 months end. At this point whoever is paying your maternity leave changes. The vague answer I got was that it changes from the insurance company to the government paying maternity leave. I'm not sure of the specifics. In any case, at this point things change a bit. The downside? Instead of getting 80% pay, you now drop to 50% of your original pay. This continues until the baby's first birthday unless you choose to go back to work. The silver lining? You don't have to pay insurance or pension during this period even though the mother and baby continue to be covered by insurance. In my particular case, Russell also happens to be covered by my insurance, and apparently he will stay covered as well - which was a big relief. I suppose the even shinier silver lining from my American readers' point of view, is that you get paid anything at all at this point.

In order to collect this 50% pay, however, you have to fill out forms every 2 months. Apparently the first time you apply (since it is a different system from the post-birth 2 month system) the payment takes a while to get to you, but after the start up phase the checks come more regularly. Though that also depends on you applying regularly every 2 months. So getting the money isn't a walk in the park, but at least there's a clear system. I assume it will actually feel more like getting a full paycheck every other month, rather than 50% pay. And it should be a healthy paycheck without insurance and pension taken out.

I also discovered that if you apply for childcare (presumably the city run system of child care?) and they don't have room for your child after his/her first birthday (not uncommon), you can apply for up to 6 months more of the 50% pay system. The only extra hurdle is having to prove every 2 months that you are on a waiting list for child care and there still isn't room. I don't plan on taking advantage of this - at least I hope I won't , but it is interesting.

I am not sure how I will go about paying (or if I need to pay) income tax on all of this. My status at work just recently changed, so for this year only, I had to pay city taxes individually (instead of having them taken out of my paycheck monthly by the university). I assume there must be some sort of national income tax as well, and I'm not sure how that will be paid. I need to check into that.

So that's how maternity leave works in Japan. As I've mentioned before, hospital costs are largely covered (if not completely covered) by a one time gift equalling around $4,000 that the city gives when the baby is born. That amount is in addition to the maternity leave described above.

I had not anticipated all the waiting to get maternity checks, but I'm not complaining. Just very glad we have some savings to fall back on...

Maternity Class #3

As I believe I mentioned before, our hospital offered three maternity classes. I missed the first one, but went to the second class on breastfeeding and today was the third class: labor and hospital tour. 

Partners were invited to this one. 

Since it was Sunday, the hospital was mostly closed down. We accidentally arrived about 30 minutes too early, so we went down to the Tully's coffee shop in the lobby and got drinks while we waited. Nice of them to be open on a Sunday morning!

Once it was time for the class, we marched back upstairs and were led into one of the classrooms. There were about 7 couples this time. I think everyone was different from the last class I took before, which surprised me a bit, since the classes are only offered once a month. 

The class largely focused on the anatomy involved in labor as well as the general process. The dads-to-be got to wear a pregnant suit and try out tying their shoes or picking things up of the ground. One fellow absentmindedly just shifted the belly off to his left to lean over and tie his right shoe. This did not net him any creativity points. 

We also learned when to contact the hospital (unlike what I've been reading for the US, the hospital here advised we call in if the water breaks or once contractions are coming 6 in an hour. We will apparently be advised from there on whether to make the trip in or wait longer at home. We were also advised to have taxis on speed dial and to learn the commute time to the hospital. 

Next, they had a massage lesson for the fathers to be. They were instructed in several different massage techniques and told to keep checking with the mother about what felt good and what didn't. Of course, the mothers were on the receiving end of this lesson. I approved of this part of the class. :)

One interesting thing that came up during the class was the question of a birth plan. I had been reading all about birth plans and what to include in them while reading books from the US, but I hadn't heard a peep about them in Japan. What little I had read of foreigners' experiences in Japan, it didn't seem like you had much say in the birthing process. My ears did perk up today, however, when the midwife reminded us to bring our birth plan with us when we check in to the hospital. They do that here? What are our choices? Is there a special form we are suppose to use? Russell and I went to investigate. 

From what I can tell, birth plans in Japan are a somewhat watered down version of what I've been reading about. We asked what sort of things we should specify and the midwife suggested things like how much the father would be involved, what sort of environment the mother would like (bright lighting vs dim lighting, music or not, etc) whether the mother was very scared of pain or any images she may have of how labor would be. Things like that. No mention of any sort of medical intervention - epidural, episiotomy, etc. Actually, now that I think about it, no mention was made at any point of episiotomies... which surprises me a little. My understanding is that they are still basically automatic in Japan (they used to be in the US as well, but seem to be more in an "as needed" status as of the last 10 years or so). We'll have to ask about that at our next appointment. 

Finally, we gathered our things and got a tour of the facilities on the way out. We got to see the shared and private rooms as well as the birthing rooms. The birthing rooms had all sorts of furniture and props to use during labor, which is nice. The private rooms, for recovering after birth, are downright spacious with furniture for visitors, a private shower, etc. The shared rooms aren't bad either. Each curtained area has a bed with lots of pillows, room for the father and presumably for the baby's cart. Showers may have to be taken down the hall, thought. 

We also got to peek in the nursery, where one baby was completely conked out and the other was screaming his head off. One of the nurses mentioned that they do rooming-in at the hospital, so I think the babies only go to the nursery if the mother requests the chance to sleep. 

So anyway- we've got about a month and a half to go. I am eligible to start maternity leave on August 23rd, but I'm planning to push it back to the start of September. I recently got the good news that I will still be paid 80% of my salary - not 2/3 as I had believed. So that's really nice. I'm not sure yet if its 80% until the baby is born and then 2/3 pay for the first two months, or 80% clear through. I'll get more information when I talk to the finance lady on Monday. I have to say, once again, that maternity leave in Japan is outstanding.

Pregnant in Japan: No cold foods!

Back around the start of my second trimester, I was invited to have a one on one chat with one of the midwives about nutrition. I'm not sure if this was because I had missed the first maternity class (which covered that topic, among other things) or if it was because I had had high blood sugar.

Incidentally, I was much more worried about my blood sugar levels than my doctor, who wasn't too worried at all once she found out I had had a large meal and a glass of mango juice about 30 minutes before the blood test. It was pretty clear why my numbers were so high.

Regardless of the reason, however, I was a candidate for some individual dietary consulting, so I met up with one of the midwives to talk food. Of course, this was the day Russell was sick, and while my doctor speaks English, the midwives generally do not. I got a lot of Japanese practice - and was very proud of how much I was able to understand. I love the midwives at this hospital, by the way, they are very patient and good about communicating.

So what did I learn?

The first part of the consultation covered the same health points that I had been reading about online - get lots of iron (I didn't know the Japanese word for iron, but she wrote "Fe"and we were good to go), eat green leafy vegetables and fish, avoid caffeine and empty calories, etc. I did get a list of specifically Japanese foods that are considered excellent sources of nutrition during pregnancy - thinks like natto (fermented soy beans), chirimen (micro fish that are used more like a seasoning), tofu, etc. I later reported these to Russell and he immediately started incorporating them into the meals he was cooking. <3 p="">
Then she transitioned to a different nutrition topic - don't eat cold foods.

Western interpretation: what, like iced drinks? cold noodles (popular in summer)? ice cream?

No - the list included tomatoes, melon, eggplant - rather a large cross section of the fruits and vegetables that are in season at the moment at the grocery store.

Was this a question of eating these foods raw or cooked?

No - but these foods are "cold" foods and, while they are certainly healthy to eat, they supposedly cause your internal organs to contract, which, since my labor will be in the heat of summer, would make things more difficult for me. Instead, she recommended I try to eat more "hot" foods - foods like broccoli and roots (carrots, potatoes, burdock root, etc) which supposedly would make my labor easier.

At this point I was catching on to what she was talking about. I thanked her politely and we finished up our discussion.

So, what did she mean by "cold foods" and "hot foods"? This comes from Chinese medicine. I don't know much about it, so take what I report with a grain of salt, but I was talking with my boss about it and she said its just something so ingrained in Japan that everyone takes it for granted. A normal healthy person is suppose to eat a balance of hot and cold foods (think Yin and Yang) for an optimal diet. Hot and cold foods are categorized partly in accordance with the season in which they are harvested. Cold foods are generally those foods which are harvested around summertime and are suppose to have a cooling effect on the body that complements the heat of summer. Foods harvested in Fall and Winter are considered hot foods. They often come from underground and are suppose to warm your body in winter. Or something like that. Apparently, if you are due to give birth in summer, shifting the balance towards warm foods is recommended for an easier labor, and that's what the midwife was talking about.

While I am trying to be good about getting a range of healthy foods into my diet, I'm afraid I'm not worrying too much about limiting "cold" foods. If its in season at a good price at the grocery store, its gettin' et.

But I appreciate the thought.

Mug Shot

Today I had another doctor's visit. Everything was healthy and average. The baby's weight is estimated at 1857g (If I am remember correctly) which is just about 4lbs. 

The last few appointments have been kind of anti-climactic for ultrasounds. In the past, the baby was small enough that you could see most of him in the view and it made it easier to tell what you were looking at. The last few visits he has gotten big enough that we can't really tell what we're looking at. The doctor always stops to measure the head and the femur and to verify which direction the baby is positioned, and we may catch a glimpse of the heart or skull, but that's about it. The last two or three visits, the doctor has tried to take a picture of the baby's face, but he hasn't been terribly cooperative. Usually she manages something, but its typically been rather skeletal. Fun to see development, but kind of disconcerting when you think of displaying it on the mantle. 

Today, we went through the same routine, but the baby had turned around and his face was very visible. He actually looked like a proportional baby and I could see his features, not just his skull. It was exciting. Apparently the doctor thought so too, because she immediately turned on her 3D imaging software - which as far as I can tell renders the image to make the skin look opaque so you can make out features better. From what I can tell, the 3D image is purely for the benefit of the parents. Many places market it as an up-sell. Russell and I had decided against getting a 3D image (its kind of creepy sometimes) but it does make it easier to tell what you're looking at. This time around was on the doctor. I think she was just excited to get such a clear angle and wanted it to be as clear as possible. 

I kind of wish I could have had the original ultrasound, too, but the doctor kindly gave me the 3D image as a gift, so I didn't say anything. 

Its a close up of his profile. You can see the side of his face with some random anatomy along the top and bottom of the picture.

And here he is:

Not even born and I'm showing off photos of him... Its only going to get worse, you know. 

Rockin' the convenience store

I've posted before about how awesome convenience stores are in Japan. They're just, well... convenient. You can actually get stuff done there. They have things you didn't think you would need but suddenly do need in the middle of the night - like digital thermometers, lightbulbs and socks. Not to mention a decent array of perfectly edible food and often a limited number of fruits and vegetables.

7-11 does have a presence in Kobe, but Family Mart and Lawson have a stronger presence from what I can tell. Lawson is probably the most prevalent convenience store around. We have two walking distance from our house.

One of the convenient things we knew we could do at the convenience store, but which we had never tried out was paying for Amazon orders. Why would you do that? As I've also mentioned in posts of yore, very few people have or use credit cards in Japan. Its a cash society. Which is difficult if you want to make a purchase online. Many online services rely on either money transfers from the bank, or allow you to print out a receipt at the local convenience store and pay there. Once you have paid, a message is sent to the company and your package is mailed.

Since Russell and I do have a credit card, we tended to just default to what was most comfortable and use that. The problem was that money was coming out of our US account (which has no income at the moment) and not out of our Japan account (which does have income). This didn't seem wise long term. Add to that the fact that I wanted to make a large purchase for the university and be reimbursed, but the US credit card registered everything in dollars - and it was even messier. I finally decided to investigate the convenience store option.

Luckily, Amazon had pretty good directions in English for how to navigate the receipt kiosk in Lawson, so I printed out the directions and my purchase code and gave it a try. Worst case scenario, I would mess something up and the order would end up being cancelled. If I managed to pay, I should be all set.

It ended up working out great. I will totally do this again in the future!

And as long as I'm raving about the convenience of the convenience store - here are some other things I got done during the same trip:

-Bought dinner (bento for Russell, sandwich, shredded cabbage and bean salad for me)
-Got $500 in cash out of the ATM (seriously... its Japan.)
-Paid my monthly bills and the ticket for the books I had ordered (total: $400... at a convenience store... at night)
-scanned the ultrasound print-out from the hospital and saved it to my USB stick.

I was feeling pretty empowered on the way home.