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Instead of directly putting the contents of the annotation appearance streams into the page's content stream, add commands to render the form xobjects directly. This is a more robust way to do it than the original solution as it works properly with patterns and avoids problems with resource name clashes between the pages and the form xobjects.
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Flatten annotations by integrating their appearance streams into the content stream of the containing page. In the case of form fields, only flatten if /NeedAppearance is false (or equivalently absent). If flattening form fields, also remove /AcroForm from the document catalog.
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This is the beginning of higher-level API support using helper classes. The goal is to be able to add more helpers without continuing to pollute QPDF's and QPDFObjectHandle's public interfaces.