I previously had this problem with my EC2 instance (I was serving couchdb to serve resources -- am considering Amazon's S3 for the future).
One thing to check (assuming Ec2) is that the couchdb port is added to your open ports within your security policy.
I specifically encountered
"[Errno 111] Connection refused"
over EC2 when the instance was stopped and started. The problem seems to be a pidfile race. The solution for me was killing couchdb (entirely and properly) via:
pkill -f couchdb
and then restarting with:
/etc/init.d/couchdb restart