The Princess of Wales ( formerly known as Kate Middleton) celebrated her 44th birthday on Jan. 9. Kate is thought to have spent the day with her husband, three children, and other loved ones just as she has so many other years. But one birthday the princess likely doesn’t look back on fondly is when she turned 27.

One day ahead of her 44th birthday, Kate Middleton made a surprise appearance alongside her husband Prince William on January 8. The Prince and Princess of Wales visited the Charing Cross Hospital in West London to speak to medical staff and volunteers.

Kate Middleton was left reeling early in her relationship with Prince William after a last-minute New Year's Eve change of plan that exposed the pressures of dating a future king and, according to a royal author, brought her close to tears.