At the end you’ll reach a special floor called Home. During the Ascent, you’ll fight your way back up through modified versions of all the previous floors. The boss room contains no boss only an item, Dad’s Note. Behind the strange door is a hole to a special Mausoleum floor.
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Somewhere on the floor you can find a skull with an X-shaped crack in it breaking it will always reward you with a 0 – The Fool card. Note that you normally cannot leave the boss room after defeating Mom you will need to have some way to teleport out before you go in and fight Mom. This will consume the item and unlock the strange door.
At the end of the Antibirth path, you will fight Mother.
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Navigating the Antibirth levels is tricky you may want to look at a separate guide to learn how to acquire the Knife Pieces and reach the Corpse.This leads to an alternate set of levels, based on the Antibirth fan mod. Defeating Hush three times will cause a new door to appear on subsequent playthroughs whenever you defeat the boss of Basement I.
Here, you will fight a powerful boss named Hush. On subsequent playthroughs, defeating Mom’s Heart (or its replacement, It Lives!) before the timer reaches 30:00 will cause a path to the Blue Womb to open up.