Cain
ReadyHold 55 coins at the same time.
Achievement
Defeat ??? as Cain.
In-game: “Unlocked a new item.”
Hold 55 coins at the same time.
Defeat Mom.
Reach Depths II and defeat Mom.
Sources:AchievementsWomb
Defeat Isaac 5 times.
After: The Womb
Defeat ??? as Cain.
After: Cain, The Womb, The Polaroid