When Ann Leonard had her baby at George Washington University Hospital this summer, a healthy daughter wasn't the only memorable delivery. A nurse also brought Leonard a bag filled with samples of detergents, diapers, ointments and baby wipes, plus coupons and offers for credit cards, life insurance, children's drugs, toys, posture bras, Christian story books and more.

The first-time mother, who works with consumer advocate Ralph Nader, counted 49 sales pitches. She was outraged.

"The fact that the nurses were handing out this corporate material was an inappropriate use of a hospital nursery," she said. "I was in a university teaching hospital, and I established a relationship with the nurses as caregivers and providers of expert advice. It was an abuse of their position for corporations to exploit that relationship."

Last month, on the strength of the 34-year-old woman's anger, Nader complained to the nation's hospitals that the rampant commercialism of maternity marketing has infected the hospital-patient relationship.

"There is no end to this aggressive mercantile mentality," Nader said. "You'd think they'd leave the maternity ward alone."

On Friday, an American Hospital Association official said Nader's complaint has pushed the group to review the issue this fall and offer guidance to more than 3,000 U.S. hospitals that deliver babies.

Here, the complaints had an immediate impact: GWU Hospital announced last month that the criticism was valid and that officials will pay more attention to the contents of gift bags. New moms at GWU no will longer be solicited to apply for credit cards or purchase books like "Alice in Bibleland" or respond to other come-ons.

"In our bags, we were surprised to find that there was solicitation to purchase printed material that had religious connotations," said Phillip S. Schaengold, chief executive of GWU Hospital. "I don't think that's appropriate. There were some products that aren't health-care related that we think have no business being there, such as specialized clothing, exercise equipment for adults, special bras, that sort of thing."

Still, even though he moved rapidly to change the gift program, Schaengold was taken aback by Nader's objections. "I think this is a non-issue," he said, adding that he won't eliminate freebies entirely. Acceptable commercial offers will still be given to new parents.

"It's not a whole lot different from what you would find in The Washington Post Sunday value pack," he said.

But national experts say the gift packages raise significant ethical, medical and social questions.

"I struggle with this in my work almost every day," said Ann L. Ropp, chairwoman-elect of the AHA maternal-child health governing council and head of maternity services for a six-hospital system based in Kansas City, Mo. "The commercial world knows that wherever babies are born there is a ready-made audience for marketing."

Hospitals have become pawns, she said, and they must exert more influence over what materials reach parents.

"There is a tremendous influence if a hospital gives a patient a product," she said. "It looks like an endorsement, whether it is or not."

The biggest concern focuses on free samples of infant formula, which critics call an insidious way of discouraging women from breast-feeding. Medical evidence strongly suggests that breast-fed babies typically are healthier and more resistant to allergies and infections than bottle-fed babies.

Because new mothers can find the first two weeks of breast-feeding painful, difficult and sometimes scary, critics say the inclusion of infant formula samples in gift bags is an ever-present temptation for mothers to give up on natural feeding--with the apparent blessing of the hospital that gave it to them.

Apart from the medical issues, Ropp said, many new mothers are susceptible to pitches for frills such as portraits, film, birth announcements and cellular phones--all of which can have a negative effect on poor families.

"If we send them home with offers for credit cards or silver spoons or a ride home in a limousine, they think they are not being kind to their babies if they don't spend this money," Ropp said. "They are struggling to pay the rent and buy groceries. To bombard them with these offers when they should concentrate on the care of their babies, I don't know that that's really right."

Marketing executives say the gifts are a harmless and nearly universal feature of the American childbirth experience.

"Not only do [mothers] enjoy the gift packs, but in hospitals where they don't have the packs, the mothers are almost upset because they are expecting it," said Steven M. Kaplan, chief executive officer of Bounty SCA Worldwide, a subsidiary of Bethesda-based Snyder Communications. "They get all this great free stuff."

It isn't a new marketing concept; for half a century, hospitals have showered free products on new mothers. Each year, they hand out goodies to 3.7 million new mothers a year. Two of the leading marketers today are Ross Laboratories, which makes the infant formula Similac, and Mead Johnson, which sells Enfamil formula.

Kaplan said his firm began supplying the gifts in 1948 and today distributes them to 4,000 U.S. hospitals.

"All the big players, anybody who does things in the baby industry, are there--from Kimberly-Clark to Johnson & Johnson to H.J. Heinz," he said.

The patterns are so established in the United States that Bounty and other firms are developing new markets in Europe, Russia and the Far East. In the United Kingdom, the health ministry pays Bounty to send a visitor to each new mother and deliver government infant-care materials along with $200 worth of products, Kaplan said.

U.S. hospitals obtain the gift packages at no charge from infant formula or marketing firms.

But some hospitals spend thousands of dollars a year to provide diaper bags emblazoned with the hospital name, and hospital employees stuff them with the free products.

Some restrict the contents to keep mothers focused on the essentials. However, even the strictest hospitals generally permit infant formula makers to hand out free samples--often to women who plan to breast-feed.

Inova Fairfax Hospital, which delivers 9,000 babies a year, limits the solicitations more than most and tailors packages to the mother's infant feeding plans.

People from throughout the nation have complained to the AHA that Nader's complaint is paternalistic and sexist.

"Nader is going a little too far in presuming that he speaks for a lot of people," said Hal Hammond, a Denver geophysicist whose wife, Xan, delivered their second child in March.

"My wife and I always enjoyed getting the gift packs. She said she looked forward to getting it because she remembered getting it before."

Lisa Ruth, a Chicago graphic designer and student, said the marketing is benign. "There are so many things going on that need our focus and attention," she said. "It's a rather petty matter."

Stephanie D. McNeill, spokeswoman for Arlington Hospital, said the diaper bags they give away are extremely popular.

"These are beautiful bags that the moms seem to like," she said. "It makes them feel special."