Death doesn't appear until The Womb, so you won't have him until you've got down there.

War only spawns in the Depths too, and he's not particularly common. Conquest is a Womb boss too, plus you have to unlock him (although nobody knows how, since it was glitched on release).

Yeah, Famine's a pain in the ass. I'm not sure which is the worst part either, his ability to spawn shooty flies at the start or the three-way bullet shot when he's just a head. Pestilence and War are both a lot easier I find. Then again Conquest is also notably easier than Death.

Then again everything is easier than Death with the exception of Isaac and possibly The Bloat, who's a gigantic ♥♥♥♥♥♥♥. Friggin laser-spewing Peep variant.

Samson is still ♥♥♥♥ too.

I have one thing to say. Death and Greed can suck my elongated flange.