The Binding of Isaac: Afterbirth †

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Afterbirth † is an expansion to The Binding of Isaac: Rebirth that was released on January 3rd, 2017 and costs $9.99.

For a list of the pre-release blog posts, see The Binding of Isaac: Afterbirth † (Pre-Release).

Nicalis, the game's publisher, also created mod tools for easier creation of community mods with the release. Nicalis are planning on having occasional updated to Afterbirth † that would incorporate certain high-quality and popular mods. These updates will be known as Booster Packs.

Features[edit | edit source]

Additions[edit | edit source]

Player[edit | edit source]

Characters[edit | edit source]

Character Apollyon App.png
Health Stat Icon.png Health HUD Red Heart.pngHUD Red Heart.png
Damage Stat Icon.png Damage 3.5 (*1.00)
Tears Stat Icon.png Tears +0
Shot Speed Stat Icon.png Shot Speed 1
Range Stat Icon.png Range 23.75
Speed Stat Icon.png Speed 1.0
Luck Stat Icon.png Luck 0
Starting Item Icon.png Starting Pickups None
Starting Item Icon.png Starting Item(s) Void

Transformations[edit | edit source]

Transformation Appearance Transformation effect Item Icon Item effect Recharge
Bookworm Bookworm Transformation.png
  • Sometimes Isaac shoots two tears at once, like 20/20. The character also gains stat increases depending on which book they are holding.
Anarchist Cookbook
Anarchist Cookbook Icon.pngSpawns six troll bombs around the room.3
Book of Revelations
Book of Revelations Icon.pngAdds 1 Soul Heart and increases the chance for the next boss to be a Horseman (except on XL floors and floors with fixed bosses such as Mom).6
Book of Secrets
Book of Secrets Icon.pngUpon use, gives the effect of Treasure Map, The Compass, or Blue Map for the duration of the current floor.6
Book of Shadows
Book of Shadows Icon.pngUpon use, creates a protective shield nullifying all types of damage for 10 seconds.3
How To Jump
How To Jump Icon.pngGives Isaac the ability to jump (over gaps, spikes, etc.).0
Satanic Bible
Satanic Bible Icon.pngUpon activation, Isaac gains a black heart.6
Telepathy For Dummies
Telepathy For Dummies Icon.pngUpon activation, grants homing tears for the current room.2
The Bible
The Bible Icon.pngUpon activation, Isaac gains Flight, allowing him to pass over all obstacles in the current room. Instantly kills Mom, Mom's Heart, and It Lives when activated, but will kill Isaac when activated while fighting Satan.6
The Book of Belial
The Book of Belial Icon.pngGuarantees a Devil Room or Angel Room will be open after beating a boss while holding it. Upon use increases damage by 2 for the current room and by a further +50% if the character also has the Blood Of The Martyr.3
The Book of Sin
The Book of Sin Icon.pngSpawns a random Pick Up, Pill, Card, or Trinket.4
The Necronomicon
The Necronomicon Icon.pngDamages all enemies in the room significantly.6
Spider Baby Spider Baby Transformation.png
  • Spawns a spider familiar that applies random status effects to enemies it comes in contact with.
Box of Spiders
Box of Spiders Icon.pngSummons 2-4 Blue Spiders.2
Mutant Spider
Mutant Spider Icon.pngGrants quadruple shot but decreases tears.
Spider Baby
Spider Baby Icon.pngWhen hit, spawns up to 2 Blue Spiders.
Spider Bite
Spider Bite Icon.pngAdds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them.
Spider Butt
Spider Butt Icon.pngDamages all enemies in the room and slows them and their projectiles down.2
Spider Mod
Spider Mod Icon.pngDisplays Isaac's tear damage and enemy health bars. Spawns a gray spider familiar that wanders around and inflicts a random status effect on any enemies it comes into contact with. Occasionally spawns a blue spider upon clearing a room.
Adult Adult Transformation.png
  • Grants a heart container.
  • Mom's foot will occasionally come down and stomp on enemies.
3 Puberty pills

Items[edit | edit source]

68 new items were added in the expansion: 19 activated items and 49 passive items.

Activated Collectibles[edit | edit source]

Name Icon Description Recharge
Brown Nugget
Brown Nugget Icon.pngSpawns a stationary fly familiar that fires tears at nearby enemies.7 seconds
Clicker Icon.pngTransforms Isaac into another random character.6
Compost Icon.pngSpawns a blue spider or fly. Turns pickups in the room into blue spiders or flies.2
Crooked Penny
Crooked Penny Icon.pngSpawns a penny and has a 50% chance to double all items and pickups in the room. If the effect fails, the items and pickups disappear.4
D1 Icon.pngDuplicates a random pickup in the room.4
D Infinity
D Infinity Icon.pngGrants a random dice item that changes each use.2
Dataminer Icon.pngDisplaces enemy sprites for the current room and increases or decreases a random stat.4
Delirious Icon.pngSpawns a random charmed boss.12
Dull Razor
Dull Razor Icon.pngHurts Isaac without depleting health, activating any items that trigger upon taking damage.2
Eden's Soul
Eden's Soul Icon.pngSpawns two item pedestals.12 (One time use)
Mama Mega!
Mama Mega! Icon.pngDamages all enemies and destroys all obstacles. The effect occurs every time a new room is entered for the rest of the floor. Opens doors to the floor's secret and super secret rooms.One time use
Metronome Icon.pngGrants a random item effect for the current room.1
Plan C
Plan C Icon.pngKills all enemies in the room, then kills Isaac three seconds later.One time use
Potato Peeler
Potato Peeler Icon.pngRemoves a heart container, increases damage and range, and grants a Cube of Meat.0
Pause Icon.pngFreezes all enemies until a fire button is pressed.2
Sharp Straw
Sharp Straw Icon.pngDamages all enemies in the room.8 seconds
Smelter Icon.pngConsumes Isaac's currently held trinket and applies its effect permanently.6
Void Icon.pngConsumes all pedestal items in the room. Active items will have their effects added to Void, and passive items will grant stat upgrades.6
Wait What?
Wait What Icon.pngIsaac farts, sending out rock waves.2

Passive Collectibles[edit | edit source]

Name Icon Description
Acid Baby
Acid Baby Icon.pngSpawns a familiar that drops random pills every 2 rooms cleared. Upon using a pill, all enemies in the room are poisoned.
Adrenaline Icon.pngIncreases damage based on how many empty heart containers Isaac has.
Analog Stick
Analog Stick Icon.pngDecreases tear delay. Allows Isaac to fire tears diagonally.
Apple! Icon.pngIncreases tears. Adds a chance to fire a high-damage razor blade.
Backstabber Icon.pngHas a chance to fire tears that inflict bleeding on enemies, causing them to slowly take damage over time.
Belly Button
Belly Button Icon.pngDrops a random trinket. Grants an extra trinket slot.
Big Chubby
Big Chubby Icon.pngSpawns a familiar that slowly charges forward and damages enemies in its path.
Bloodshot Eye
Bloodshot Eye Icon.pngSpawns an orbiting eye familiar that fires tears every 2 seconds.
Camo Undies
Camo Undies Icon.pngIsaac becomes camouflaged at the beginning of each room. Enemies will not attack Isaac until he starts firing tears.
Compound Fracture
Compound Fracture Icon.pngIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
Cone Head
Cone Head Icon.pngGrants a soul heart. Adds a chance to block enemy shots.
Contagion Icon.pngThe first enemy killed in a room explodes and poisons nearby enemies. Poisoned enemies will also explode upon death.
Dad's Lost Coin
Dad's Lost Coin Icon.pngIncreases range by 1.5. Drops a Lucky Penny. Other Effects Unknown
Dark Prince's Crown
Dark Prince's Crown Icon.pngIncreases range, tears, and shot speed when at exactly one red heart.
Dead Tooth
Dead Tooth Icon.pngWhile firing, Isaac gains a green aura that poisons nearby enemies.
Depression Icon.pngSpawns a cloud familiar that leaves a trail of tears that damages enemies. Has a chance to spawn damaging beams of light onto enemies that touch the cloud.
Dog Tooth
Dog Tooth Icon.pngIncreases damage and speed. Upon entering a room adjacent to a secret room, a howl sound effect will play.
Duality Icon.pngWhenever a Devil or Angel Room would spawn after defeating a boss, both rooms spawn. Only one can be entered.
Eucharist Icon.pngAn Angel Room door will always spawn after every boss fight, excluding the first floor and floors after Utero II/Womb II.
Euthanasia Icon.pngAdds a chance to fire needles. If a needle kills an enemy, it bursts into more needles.
Eye Of Belial
Eye Of Belial Icon.pngGrants piercing tears. After piercing one enemy, tears start homing and deal double damage.
Eye Of Greed
Eye Of Greed Icon.pngAdds a chance to fire tears that temporarily stun enemies and turn them into gold. Any enemy killed while in this state will drop coins.
Finger! Icon.pngSpawns a finger familiar that points at enemies, dealing constant damage.
Ghost Pepper
Ghost Pepper Icon.pngAdds a chance to shoot a fire that damages enemies and remains in place until it deals enough damage or the room is left.
Glaucoma Icon.pngAdds a chance to shoot concussive tears, causing enemies to walk around randomly.
Glyph Of Balance
Glyph Of Balance Icon.pngGrants 2 soul hearts and modifies drops from Champion Monsters based on certain conditions
Greed's Gullet
Greed's Gullet Icon.pngGrants a heart container for every 25 coins Isaac has.
Hushy Icon.pngSpawns a Hush familiar that bounces around the room and deals contact damage. While firing tears, it stops moving.
Jacob's Ladder
Jacob's Ladder Icon.pngTears fire sparks of electricity in random directions upon hitting an obstacle or enemy.
King Baby
King Baby Icon.pngSpawns a familiar that follows Isaac and makes other familiars follow it. While firing tears, it stops moving.
Large Zit
Large Zit Icon.pngAdds a chance to fire a creep shot that deals double damage and leaves a trail of slowing white creep.
Lead Pencil
Lead Pencil Icon.pngAfter every 15 tears fired, Isaac will fire a high-damage cluster of tears.
Lil Monstro
Lil Monstro Icon.pngSpawns a familiar that fires clusters of tears. Must be charged before shooting.
Linger Bean
Linger Bean Icon.pngAdds a chance to fire a gas cloud that damages nearby enemies.
Little Horn
Little Horn (Item) Icon.pngAdds a chance to fire a piercing tear that instantly kills any enemy that it touches.
Metal Plate
Metal Plate Icon.pngAdds a chance to reflect enemy shots. Grants one soul heart.
Moldy Bread
Moldy Bread Icon.pngGrants a heart container.
Mom's Razor
Mom's Razor Icon.pngSpawns an orbiting razor that damages enemies it touches and inflicts bleeding on enemies, causing them to slowly take damage over time.
Parasitoid Icon.pngAdds a chance to fire an egg sack which spawns slowing creep and spawns a blue fly or spider upon hitting an enemy.
Poke Go
Poke Go Icon.pngUpon entering a room with enemies in it, has a chance to spawn a random charmed enemy that persists across rooms.
Polydactyly Icon.pngAllows Isaac to carry two cards, pills, or any combination of both at the same time. Drops a random card or pill.
Sack Of Sacks
Sack Of Sacks Icon.pngSpawns a sack familiar that has a chance to drop a sack upon clearing a room.
Shade Icon.pngSpawns a shadow familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.
Shard Of Glass
Shard Of Glass Icon.pngUpon taking damage, Isaac has a chance to drop a full red heart, gain 5 range, and leave a trail of damaging red creep for the current room.
Sinus Infection
Sinus Infection Icon.pngAdds a chance to fire a booger which sticks to enemies and poisons them.
Sulfuric Acid
Sulfuric Acid Icon.pngIncreases damage. Adds a chance to fire acidic tears which can destroy obstacles.
Tarot Cloth
Tarot Cloth Icon.pngDrops a random card or rune. Doubles the effects of cards and runes.
Varicose Veins
Varicose Veins Icon.pngTaking damage releases a ring of 10 high damage tears.
YO LISTEN! Icon.pngIncreases luck. Spawns a fairy familiar that points out secret room entrances and tinted rocks.

Trinkets[edit | edit source]

29 new trinkets were added in the expansion.

Item Icon Effect
Bag Lunch
Bag Lunch Icon.pngTaking damage has a small chance to destroy the trinket and spawn Lunch.
Bat Wing
Bat Wing Icon.pngUpon taking damage, has a chance to grant flight for the rest of the room.
Black Tooth
Black Tooth Icon.pngAdds a chance to fire a black tooth that poisons enemies.
Bloody Crown
Bloody Crown Icon.pngTreasure Rooms appear in Chapter 4.
Crow Heart
Crow Heart Icon.pngRed heart damage will be taken before soul and black heart damage.
Cracked Crown
Cracked Crown Icon.pngGrants extra stat upgrades based on Isaac's passive items that increase stats.
Dim Bulb
Dim Bulb Icon.pngProvides a boost to all stats when Isaac's active item is completely uncharged.
Duct Tape
Duct Tape Icon.pngStops Isaac's familiars from moving.
Equality! Icon.pngTurns pickups into their doubled versions while Isaac's numbers of coins, bombs and keys are equal.
Fish Tail
Fish Tail Icon.pngItems and trinkets that generate blue flies or blue spiders will generate twice as many.
Fragmented Card
Fragmented Card Icon.pngMakes two Secret Rooms spawn on each floor.
Locust Of Conquest
Locust Of Conquest Icon.pngUpon entering a room with enemies, spawns 2-5 White Locusts which damage enemies.
Locust Of Death
Locust Of Death Icon.pngUpon entering a room with enemies, spawns a Black Locust that does a very high amount of damage.
Locust Of Famine
Locust Of Famine Icon.pngUpon entering a room with enemies, spawns a Yellow Locust that damages and slows enemies.
Locust Of Pestilence
Locust Of Pestilence Icon.pngUpon entering a room with enemies, spawns a Green Locust which damages and poisons enemies.
Locust Of Wrath
Locust Of Wrath Icon.pngUpon entering a room with enemies, spawns a Red Locust which detonates upon impact with enemies.
Lost Cork
Lost Cork Icon.pngIncreases the radius of any creep produced by Isaac.
Meconium Icon.pngPoop has a chance to turn into black poop.
Nose Goblin
Nose Goblin Icon.pngChance to fire a booger that sticks to enemies and deals damage over time.
Ouroboros Worm
Ouroboros Worm Icon.pngTears travel in a large spiral pattern and become spectral.
Pay To Win
Pay To Win Icon.pngRestock Boxes always spawn in Item Rooms.
Silver Dollar
Silver Dollar Icon.pngShops appear in Chapter 4.
Stem Cell
Stem Cell Icon.pngHeals for half a heart upon traveling to the next floor.
Super Ball
Super Ball Icon.pngMakes tears have a chance to bounce off enemies and obstacles.
Tonsil Icon.pngWhen hit, there is a small chance a removed tonsil familiar starts following Isaac, blocking enemy shots.
Used Diaper
Used Diaper Icon.pngGrants the Skatole effect in some rooms.
Vibrant Bulb
Vibrant Bulb Icon.pngProvides a boost to all stats when Isaac's active item is fully charged.
Walnut Icon.pngTaking damage has a small chance to destroy the trinket and spawn various pickups.
Wish Bone
Wish Bone Icon.pngTaking damage has a small chance to destroy the trinket and spawn a random item.

Pickups[edit | edit source]

Pickups & Chests[edit | edit source]

Name Icon Effects
Scared Hearts Red heart.png Identical to the standard Red Heart, but will run away as the player moves towards it.
Half Soul Hearts Half soul heart.png Half soul hearts are a variant of normal soul hearts added in Afterbirth+ that only add half a heart to the end of the normal bar. They are unlocked after getting the "Mr. Resetter!" achievement, which is granted after the player resets seven runs in quick succession.
Blended Hearts Red soul heart.png A heart variant added in Afterbirth+ which will fill up a full red Heart Container, but will act as a Soul Heart when no Containers are free.
Charged Keys Key.png Charged Keys grant a key and fully charge your currently held active item upon pickup. Can be differentiated from regular keys by having a pulsating white glow while on the ground. Unlocked after beating Challenge #33: Pokey Mans.
Mimics Mimic Chest.png Mimics appear similar to Brown Chests until Isaac moves near, at which point they sprout spikes that damage the player as a Spike Chest would. They can be distinguished from Brown Chests by their darker, purplish-brown coloring, a spot of blood on the lower-right corner, and the grayish spot on each side of the latch where the spikes will sprout from.

Pills[edit | edit source]

Pill Effect
Needs to be unlocked Feels like I'm walking on sunshine!

Temporarily makes Isaac invincible, similar to Unicorn Stump.
Unlocked by acquiring the Sin Collector achievement.

Needs to be unlocked Gulp!

Upon use, any trinkets that the player is holding are destroyed, and their effects are permanently applied to the player.
Unlocked by acquiring the Once More With Feeling! achievement.

Needs to be unlocked Horf!

Upon use, Isaac shoots an explosive tear with the Ipecac effect.
Unlocked by acquiring the Dedication achievement.

I'm Drowsy...

Upon use, slows all enemies for the duration of the room.

I'm Excited!!!

Upon use, increases the speed of all enemies for the duration of the room.

Something's wrong...

Creates a pool of black creep beneath Isaac.

Needs to be unlocked Vurp!

Throws up the last pill you used.
Unlocked by acquiring the U Broke It! achievement.


Creates a pool of slippery brown creep underneath Isaac.

Cards & Runes[edit | edit source]

Name ID Icon Message Effect
Ace of Clubs Afterbirth† Indicator.png27 Ace of Clubs Icon.png"Convert all"Turns all pickups and chests in the room into bombs.
Ace of Spades Afterbirth† Indicator.png29 Ace of Spades (card) Icon.png"Convert all"Turns all pickups and chests in the room into keys.
Ace of Diamonds Afterbirth† Indicator.png28 Ace of Diamonds Icon.png"Convert all"Turns all pickups and chests in the room into coins.
Ace of Hearts Afterbirth† Indicator.png30 Ace of Hearts Icon.png"Convert all"Turns all pickups and chests in the room into random heart pickups.
Holy Card Afterbirth† Indicator.png51 Holy Card Icon.png"You feel protected"Gives Holy Mantle effect for current room
Rune ID Icon Message Unlocked by completing Effect
Black Rune Afterbirth† Indicator.png 41 Black Rune Icon.png


Greedier Mode as Apollyon

Deals 40 damage to all enemies in the room. Consumes all pickups in the room and turns them into blue flies and spiders. Consumes all pedestal items in the room and turns them into random stat upgrades.

NPCs[edit | edit source]

Monsters[edit | edit source]

Monster Description
Afterbirth† Indicator.png
Slowly hops towards Isaac, occasionally spawning black smoke balls. Spawns a Sack upon death.
Mushroom (Enemy).png
Afterbirth† Indicator.png
Stationary enemy that occasionally pops up and fires four shots in the cardinal or diagonal directions. Takes less damage while its head is down.
Afterbirth† Indicator.png
Hops towards Isaac, occasionally spitting out a cluster of disorganized shots.
Nerve Ending 2
Nerve Ending 2.png
Afterbirth† Indicator.png
Static enemy which whips at Isaac if he gets too close.
Poison Mind
Poison Mind.png
Afterbirth† Indicator.png
Slowly crawls around the room diagonally, leaving a trail of green creep.
Afterbirth† Indicator.png
Continually spawns enemies from the current floor until it is killed.
Afterbirth† Indicator.png
Chases Isaac and blocks tears, but does not deal contact damage. Invulnerable; dies when the room is cleared.
The Thing
The Thing.png
Afterbirth† Indicator.png
Crawls along a wall and attempts to line up with Isaac, then spits a line of damaging red creep.

Bosses[edit | edit source]

Four new bosses were added to Afterbirth †. Additionally, Ultra Greed received a second form in Greed Mode's hard mode.

Boss Rag Mega.png
Boss Big Horn.png
Boss Sisters Vis.png
Boss Delirium.png
Boss Ultra Greedier.png
Rag Mega Big Horn Sisters Vis Delirium Ultra Greedier

Environment[edit | edit source]

Chapters[edit | edit source]

The Void.png
The Void

Challenges[edit | edit source]

Name Conditions Goal Unlocked by Unlocks
31. Backasswards Isaac starts at Mega Satan fight with 10 random items.

All Chapters progress in reverse order, losing 1 item and 1 red heart container each floor you ascend.

No treasure rooms. Shops available.

The Basement Killing ??? or The Lamb for the first time Lazarus bleeds more.
32. Aprils Fool The minimap displays the floor's layout accurately, but displays Isaac's position inaccurately.

Pedestal items and pickups are not what they appear to be. Active item, pill, card, and rune effects are randomized upon each use, making them very unreliable or deadly (for example Suicide King). Items with no charge time (i.e. How To Jump, IV Bag, etc) can be used repeatedly for random effects. Trinkets function normally.

Every boss is The Bloat.

Isaac's health is not what it appears to be. Key and bomb numbers are accurate.

Treasure Rooms and Shops available.

Mom's Heart Killing Mom for the first time Magdalene starts with a Speed Up Pill.
33. Pokey Mans Starts with: Friendly Ball and Mom's Eyeshadow.

Each use of Friendly Ball causes a random monster to be spawned. Friendly Ball instantly charges once the spawned monster is killed.

No treasure rooms. Shops available.

Isaac (Boss) Unlocking It Lives! Charged Key
34. Ultra Hard Starts with: Key Piece 1 and Key Piece 2.

Permanent Curse of the Labyrinth, Curse of the Blind, Curse of the Lost, and Curse of the Maze.

All enemies spawn as champions if possible.

Boss fights will be double trouble if possible.

No heart pickups drop.

Treasure Rooms and Shops available.

Mega Satan Killing ??? or The Lamb for the first time Samson starts with the Child's Heart
35. Pong Starts with: Rubber Cement, Cupid's Arrow.

Damage fixed at 100, tear delay fixed at 150.

No treasure rooms. Shops available.

??? Unlocking The Polaroid Greed's Gullet

SmallIsaac.png The Binding of Isaac: Rebirth SmallIsaac.png

MainPageAchievements.png Achievements MainPageAttributes.png Attributes MainPageBosses.png Bosses TarotCard.png Cards and Runes MainPageChallenges.png Challenges MainPageChapters.png Chapters
Isaac App.png Characters MainPageBabies.png Co-op Magic Mushroom Icon.png Items Isaac's Tears Icon.png Item Pools MainPageMonsters.png Monsters MainPageObjects.png Objects
Red heart.png Pickups BlueBlue.png Pills MainPageRooms.png Rooms MainPageSeeds2.png Seeds Guppy App.png Transformations The Left Hand Icon.png Trinkets