Background: Birth preparedness and complication readiness is an approach that inspires pregnant women, their families and individuals to successfully design strategy for childbirths and deal with emergencies. In developing countries, world health organization estimates that more than 300 million women suffer from short-term and long-term complications related to pregnancy and child birth. In Ethiopia only 32% women have birth preparedness. The aim of this study is to assess practice and Associated factors of birth preparedness and complication readiness among Women Yirgalem General Hospital, Sidama Zone, Southern Ethiopia, 2019Methods: Facility based cross-sectional study was conducted from September 1st to 30th, 2019. A total of 422 pregnant women were randomly selected and interviewed by using pretested structured questionnaire. Data was entered by Epi-data version 3.1 and the analysis was done by SPSS version 21. Bivariate and multivariable logistic regression was performed to identify factors associated with birth preparedness and complication readiness.Result: From 422 study participants, 356(48.6%) (95% CI: 46.9%, 49.8%) have birth preparedness and complication readiness practice. Age of respondent ≥ 37 years (AOR =4.2, 95% C.I =1.23, 14.24) and between 25 to 30 (AOR=2.35, 95% C.I =1.1, 5.1); level of education College and above(AOR=5.59, 95% C.I 2.8, 11.2)and secondary school (AOR=9.5, 95% C.I 3.99-22); previous history of ANC follow up (AOR=4.33, 95% C.I = 2.46, 7.61) and history of birth at health facility (AOR=3.09, 95% C.I= 1.72, 5.56) where factors associated with birth preparedness and complication readiness practice. Conclusion: Relatively higher birth preparedness and complication readiness practice was observed in this study when compared with previous studies. Health extension workers and health care provider should encouraged women to actively utilize the health services and the governments with other stakeholders should works on antenatal care and institutional delivery by focusing on women those has no formal education.