All of my quilts are hand stitched. I use a single layer of thread, hiding each knot. I found using a hoop and starting in the middle helps keep the material tight enough to ward off those puckers. Sometimes I use the floor quilt frame - other times I feel the need to have the quilt in my lap and use the lap quilt hoop. When I get to the edges, I take off the hoop and lay it in my lap, tightening with safety pins - again to keep the puckers out. I'm not one who can use a thimble on both hands, so my main thimble is on my sewing hand, and my fingers take turns underneath the quilt, making sure the needle goes all the way through. I use the up and down method, depending on the design of the quilting. The quilting is consistent with pattern.