Special occasion gift for me too, and then I tend to ask the future recipient what they would like (in general terms). For example: if I am planning to give one to an expectant mum I ask her if she wants a baby quilt to hang on the wall, or one to be used, and what sort of general colors she would like. I take the designing from there. If I know a baby quilt will be used by the baby (!) I make it differently from the way I would do it otherwise - and I don't put a hanging pocket on it!
The one and only time I made a large quilt as a surprise for the recipient I think she was taken aback, and might have preferred something a little different. This is just a feeling...but you know how you can just tell, sometimes! And since it was my mother-in-law I think she may feel she needs to put it out every time we visit. I wish I had asked her beforehand...
Alison