Background: The birth preparedness and complications readiness (BPCR) concept are a global safe motherhood strategy and an important aspect of the antenatal care (ANC) package in reducing maternal mortality. Aim: assess the factors associated with birth preparedness and complications readiness among pregnant women. Design: A descriptive cross-sectional design. Subjects: A convenient sample of 316 pregnant women who attended the Antenatal Clinics of New Obstetric and Gynecological Hospital, Mansoura University Hospitals, Mansoura City, Egypt. Data collection tools: A structured interview questionnaire of five parts; demographic characteristics, reproductive health factors of the pregnant women, level of birth preparedness and complications readiness, knowledge of key obstetric danger signs, and attitude and perception about BPCR. Results: 50.6% of women mentioned the health facility, while only 32.3% were well prepared. Most (84.5%) women were less knowledgeable, and 68.7% had a positive attitude and perceptions toward BPCR. Demographic factors including age, education level, employment status, income perception, and place of residence were associated with women's knowledge levels. Similarly, these demographic factors (age, education, employment, and income perception) and reproductive historical elements (gravidity, parity, timing of first antenatal care visit, and receipt of birth preparedness counseling) were linked to women's attitudes. Conclusion: less knowledgeability, low preparedness, and positive attitude levels among pregnant women regarding BPCR were observed. Maternal age, education, marital condition, employment, parity, and gestational age were associated with BPCR. Recommendations: Effective health information and promotion programs should be implemented with greater attention to the importance of birth preparedness and complications readiness for all pregnant women.