I haven't read the other replies but here is my humble opinion:

Do you think women should have to give informed consent for an episiotomy? Yes for sure. It's a surgical procedure in my opinion and no different to any other surgery.

Do you think that it is ok for HCPs to assume consent (for an episiotomy) if consent has been given for vacc or forceps? No it's not ok. Consent for one procedure does not carry over into another. Vacc and forceps are not surgical and they are different procedures with different risks.

Do you think that it is ok for HCPs to assume consent (for an episiotomy) because a woman is in labour and has entered a hospital? No it's never ok to assume consent, regardless of the circumstances. Having said that, I think that labouring women in hospitals are assumed to agree to a wide range of HCP decisions all the time.

Do you think it is ok for a woman to refuse a procedure? When/Why? When is it not ok? It is always ok to refuse. As long as she's conscious and has the cognitive capacity to make her own decisions (by that I mean that she was not intellectually disabled etc prior to becoming pregnant). If there were a situation where the woman had become unconscious and could no longer participate in the decision making process AND her HCP believed strongly that to not perform an episiotomy (or any other procedure) would put her life or the baby's life in real danger then I think they can go ahead without consent, but they should still be getting consent of the birth support person if one is present. Other than that, I think it's up to the woman. She needs all the issues and risks/benefits explained calmly and without emotive language. Most (if not all) labouring women want what is best for their baby but it comes down to trusting the HCP that there is no other workable solution and the risks of not conducting the episiotomy outweigh the risks of doing it. Sometimes I think when HCP's take the time to fully discuss all the issues and gain true informed consent, (rather than just telling the woman what they need to do as I experienced), then it can open up discussion and other ideas can be considered. Even if the outcome remains the same, the fact of having gained true informed consent is MASSIVE imo.