When used to make a quilt, this larger patchwork or pieced design becomes the "top" of a three layered quilt, the middle layer being the batting, and the bottom layer the backing. To keep the batting from shifting a patchwork or pieced quilt is often quilted by hand or machine using a running stitch which can outline the individual shapes that make up the pieced top, or the quilting stitches can be random or highly ordered overall patterns that contrast with the patchwork composition.

In the past hand quilting was often done in a group around a frame. Instead of quilting, the layers are sometimes tied together at regular intervals with pieces of yarn, a practice known as tying or knotting. There are three traditional structures used to construct a patchwork or pieced composition: 1) block, 2) overall, and 3) strip piecing. Traditional patchwork has identifying names based on the arrangement of colors and shapes.

Today, many quilts are quilted using a Longarm quilting system. The system consists of a frame and a sewing machine. The patchwork, batting and backing are loaded onto the frame and in some systems each layer can be tensioned independently. No basting is usually necessary. The frames can be up to 14' long which is big enough for a king size quilt to be tensioned ready for quilting. The sewing machine known as the Longarm machine has an extended throat space - up to 36" - and can be moved on a 2-axis rail system- left and right, forwards and backwards enabling a 360 degree movement over the surface of the quilt. Until recently most longarm machines were hand-guided which meant the operator had to synchronise the speed of their hands with the speed of the machine motor. Fast hands, slow motor meant big stitches. Slow hands, fast motor meant small stitches. Since just after the turn of the century most longarm machines are now sold with stitch-regulation, which means the operator no longer has to synchronise hand speed with the motor. Electronics in the machine ensures the stitch length remains constant. More recently fully computerised machines are being sold. Fully computerised machines have been available for over 12 years. They were invented by Paul Statler but have only recently become popular. These machines use specialised machine-driver software and 'cad'-type drawing packages to enable pattern digitisation and automatic quilting. An operator is still required to mind the machine and set the pattern onto the quilt. It is thought that over 10,000 longarm quilting machines are in use today. There are many brands available and many places to obtain training.1