Raising two young children in states that don’t recognise that their parents are married has caused couple, Nicole and Pam Yorksmith, a range of problems.

They live in Kentucky and work in neighbouring Ohio – both states that ban same-sex marriage. This has complicated school enrolment, benefits, travel, tax and, most worrisome, medical emergencies.

While they consider themselves co-parents of the children that Nicole, 35, delivered after artificial insemination, a lot of other institutions don’t see them that way.

That was a problem when 9-month-old Orion came down with croup in the middle of the night.

“He had really laboured breathing,” Pam recalled. Their paediatrician recommended taking him to the emergency room, and since 4-year-old Grayden was asleep, Nicole stayed home with him.

But Pam wasn’t listed on Orion’s birth certificate or records – “An hour later, they had to call Nicole. They have to call my wife to get permission to treat my child.”

Orion recovered, but it was a troubling reminder that as much as they want to live as a normal family since their 2008 marriage in California, they face obstacles.

I’m a very traditional person. We knew very early on that we wanted to get married and have a family — let’s get a house, let’s get married, then let’s have kids. And that’s what we did.”