Even with small quilts, I start in the center, stitch in the ditch for example, pinning the seam. I check underneath with my left hand to make sure there is no gathering. It's a lot of work - BUT after I do the first seam, I take the quilt out of the sewing machine and pulling the backing taut and pinning the next seam, I repeat, checking on the back etc. Then again - as above. By the time the first set of seams are sewed, it is a bit easier to quilt the opposite seams. ALWAYS BEGIN SEWING AT THE SAME EDGE OF THE QUILT. Otherwise there is some pulling and it creates problems. Hope this helps.