I quilt in all directions. But I use a special thumb thimble to quilt away from myself and an "edged" thimble to quilt in the other directions. The "edge" on the thimble keeps the needle from slipping off the thimble.
http://www.quiltknit.com/NT202-TEDS-...LE_p_1397.html
http://www.clotilde.com/detail.html?prod_id=8220
I put the needle straight down into the sandwich and then using the rocking motion, put 3-5 stitches on the needle before pulling it through.
I use a latex finger cot on the index finger of my sewing hand to help me hold onto the needle and pull it through the sandwich.
http://www.brucemedical.com/latfincot.html
I have an "ergonomic" quilting frame that tilts so that I don't stress my back, neck and arms. And I use an adjustable stenographer's chair, again, for the same reason.
I sit back, put on the TV or listen to audiobooks on my MP3 player, and enjoy the ride. Hours pass when I'm handquilting and I don't even notice...it seems like minutes because I'm in my own little "heaven".