IMHO self hosting your database (even in the cloud) is the best way to do it. You have control over the version. You have control over features. You have control over performance. It’s tons cheaper for greater performance - especially when you go over a few hundred gigs. Yes, the hosted ones have built in replication - but my data is far too valuable to put in the hands of a third party. If they lost it - they could…
As with most things in infrastructure, it is a tradeoff to be considered properly. A startup, where you'd rather have your engineers working on adding features to your product instead of "managing and operating" a database? Have a lot of money to throw at this problem, being aware that you are paying for convenience? then using RDS and such would probably be a better choice. An established company/product with a team…
Applying migrations? initial setup and configuration?