I've used both binding and pulled the backing to the front for binding. In both cases, after securing the separate binding, I've used a decorative stitch (since I have them on my machine) for securing the binding by machine vs. by hand as that is their preference. I came to the conclusion that the decorative stitches would hide my ineptitude a bit better! They anticipate that the quilts are washed on a daily basis during hospitalization which is why they require all machine work. (this is all per their kit instructions and conversations I've had with their volunteers).