Between Death and Life is an active item in neverbirth, a mod for The Binding of Isaac.

On pickupConsumes itself and starts the Death Certificate trial for the rest of the run.

Newly spawned enemies outside the activation room become champions when possible; enemies that cannot become champions are strengthened instead.

Clearing a boss room grants one Death Certificate per floor.

A floor whose boss room was already cleared before activation grants no reward.

This item contributes towards the Leviathan transformation. Collecting 3 items from this set will grant Isaac flight and +2 Black Hearts.

Between Death and Life can be found in the following item pools:

The following tags are applied to this item:

The trial affects the whole run, including co-op, and persists when continuing.

Additional copies do not stack its difficulty or rewards.

The room where the trial began is excluded from enemy strengthening.

Existing enemies are not retroactively upgraded.

Friendly enemies are excluded.

If champion conversion fails, ordinary enemies receive about 35% more maximum HP and 5% more movement speed; bosses receive about 50% more maximum HP and 8% more movement speed.

HP is rounded and increases by at least 1; the added maximum HP is also added to current HP.

Death Certificate appears near the cleared boss room's center.

Multiple boss rooms on one floor still grant at most one certificate.

Previously cleared floors are ineligible.

The published XML lists a 12-room active charge.

Normal pickup activates the trial without needing charge and removes the item.

The manual-use fallback requires all 12 charges.

• Download neverbirth from the Steam Workshop.