Avoidable mortality and morbidity remains a formidable challenge in many developing countries like Tanzania. Birth preparedness and complication readiness by mothers are critical in reducing morbidities and mortalities due to these complications. The aim of this study was to assess knowledge and practices with respect to birth preparedness and complication readiness among women in Mpwapwa district in Tanzania. A total of 600 women who became pregnant and or gave birth two years preceding the survey were interviewed. Among them 587 (97.8%) attended antenatal clinic (ANC) at least once during their last pregnancy. Two thirds of those who attended ANC made four or more visits. The median gestation age at booking for antenatal care was 16 weeks. However, 73.9% the women booked after 16 weeks of gestation. Two thirds of the women were 20-34years old and had at least primary education level. Three hundred and forty six (57.7%) had parity between two and four. Only 14.8% of the women knew three or more obstetric danger signs. The obstetric danger signs most commonly known included vaginal bleeding during pregnancy (19%), foul smelling vaginal discharge (15%) and baby stops moving (14.3%). The majority (86.2%) of the women had decisions made on place of delivery, a person to make final decision, a person to assist during delivery, someone to take care of the family and a person to escort her to health facility. Majority (68.1%) of the women planned to be delivered by skilled attendant. One third of the women planned to deliver at home in the absence of a skilled birth attendant. In the bivariate analysis, age of the woman, education, marital status, number of ANC visits and knowing ≥3 obstetric danger signs were associated with birth preparedness and complication readiness. In multivariate logistic regression analysis, women with primary education and above were twice more likely to be prepared and ready for birth and complications. Women who knew ≥3 obstetric danger signs were 3 times more likely to be prepared for birth and complications. In conclusion, women with higher level of education and those who knew obstetric complications were more prepared for birth and complications. Further studies are recommended to find out why women do not prepare for birth or complications especially that need blood transfusion.