On my double sided quilts, I quilt to suit my dominant side and let the stitches fall where they may on the back. Echoing flowers on the front gave the pieced back on my daughter's quilt a new dimension, but we liked it.
http://www.quiltingboard.com/picture...e-t192881.html
On this one with I did try to avoid in the eyes in the pictures on the back while thread painting the animals on the front.
http://www.quiltingboard.com/picture...r-t174360.html