Diane, I don't use a hoop and I don't use a thimble on my left hand. I use safety pins and if necessary, I hand baste. I am able to use my left hand to "pinch" the fabric onto the needle with my left thumb on top and my other fingers underneath. I have only hand quilted QAYG blocks this way, but I can get really small stitches. When I use a hoop for larger pieces I place it loosely in the hoop, that way I can still pinch the fabric from underneath. I don't have any problems with puckers on the back because I can feel the fabric. I will have to tell you that I have some pretty big callouses on two fingers on my left hand and it took some practice to not draw blood, but to me it was worth it. I am going to try using the "Aunt Becky" on my next project. If you haven't heard of it, Google it, it is pretty neat. If you have any questions, please PM me.